Efficacy and late complications of laparoscopic pyeloplasty: experience involving 125 consecutive ureters

Feasibility, safety and effectiveness of laparoscopic transperitoneal pyeloplasty in children: Ain Shams University early experience

Background/purpose

Laparoscopic pyeloplasty (LP) is now widely recognized as a minimally invasive alternative for the surgical repair of ureteropelvic junction obstruction (UPJO) in paediatrics. In this work, we aim to evaluate the feasibility, safety and effectiveness of LP in our early experience.

Patients and methods

Between April 2019 and April 2020, patients presented with indication for surgical repair of UPJO were offered laparoscopic transperitoneal Anderson-Hynes pyeloplasty. Demographic data, preoperative investigations, operative data and intra- or postoperative complications, as well as short and mid-term follow-ups were recorded.

Results

During the specified period, 13 patients underwent LP (8 girls and 5 boys) with a median age of 12 months (range from 5 to 150 months). There was no conversion to open approach with operative time ranging from 120 to 240 min (mean = 175 ± 34 min). No intra- or postoperative complications were encountered. One to 2 years postoperative follow-up was performed (median = 18 months) in 11 patients. One patient discontinued follow-up after 1 month and another after 6 months. Follow-up PAUS showed a reduction in the anteroposterior diameter of the renal pelvis in all cases. Postoperative diuretic renal scans (DTPA renography) were done for three patients with a persistent anteroposterior diameter of the renal pelvis greater than 20 mm which showed improvement in the washout. All patients had a good cosmetic outcome.

Conclusion

In our early experience in LP, we found the procedure a safe, feasible and effective technique in managing UPJO in children and infants with good cosmetic outcome.

Level of evidence

This is a case series study (level IV evidence).

Late outcomes of laparoscopic pyeloplasty: a single institution study with follow-up longer than 5 years

INTRODUCTION

Although most urologists agree that failures after laparoscopic pyeloplasty occur usually within a year after the operation, late failures are also reported.

AIM

To assess late results of laparoscopic pyeloplasty.

MATERIAL AND METHODS

Seventy-eight of ninety-five patients who had been operated on between November 2001 and September 2009 were notified about the possibility of diuretic renography (DR). Excluded from the study were 3 patients who failed within 1 year after surgery, 2 others with late recurrences at 1.5 and 2.5 years postoperatively, 8 patients who were lost to follow-up immediately after the operation, 2 patients with equivocal DR after pyeloplasty and 2 cases with open conversion. Twenty-six (33.3%) patients responded to the notification. Mean follow-up was 89 months. In all patients DR, ultrasound, serum creatinine concentration, estimatated glomerular filtration rate and the assessment of symptoms were carried out. Success was defined as T1/2 ≤ 12 min and improved or stable differential renal function on DR.

RESULTS

Diuretic renography revealed no obstruction in 25/26 (96%) patients. One woman was not appropriately hydrated, which rendered the result of the investigation unreliable. Mean half time to tracer clearance was 6.74 min. Mean split renal function on the operated side was 44.62%. Mean pain strength according to the VAS scale was 1.54.

CONCLUSIONS

Our study seems to indicate that recurrence after laparoscopic pyeloplasty in the follow-up period longer than 5 years is very unlikely. However, until more data are available, patients should undergo long-term follow-up to receive the benefit of the operation.