Лапароскопическая пиелопластика при рецидивной стриктуре пиелоуретерального сегмента

Abstract

Pyeloplasty represents main treatment method of patients with primary ureteropelvic obstruction (UPJ). In recurrent UPJ obstruction endopyelothomy is performed more commonly and in case of its failure a repeated pyeloplasty can be done. The aim of the study was to assess the results of laparoscopic pyeloplasty in these recurrent cases. A total of 178 laparoscopic pyeloplasty was performed in urologic clinic from February 2010 to March 2018. In 18 patients (10.1%), including 11 men and 7 women, recurrent UPJ obstruction was diagnosed. Mean age was 36.5+/-8.0 years. There were 12 left UPJ obstruction and 6 right UPJ obstruction. Previously, 10 and 8 patients undergone open and laparoscopic pyeloplasty, respectively. Retrograde pyelothomy was done in 12 cases (75.0%). All patients had clinical symptoms and obstructive curve pattern on dynamic scintigraphy. Intra- and postoperative complications were graded using Clavien classification. The results of laparoscopic pyeloplasty were evaluated by excretory urography and dynamic scintigraphy. There was no conversion. Mean duration of laparoscopic pyeloplasty was 105.5+/-28 min. The surgery was more prolonged in patients who previously undergone transperitoneal laparoscopic pyeloplasty. Conversely, laparoscopic pyeloplasty after failed open retroperitoneal pyeloplasty was less complicated. Mean blood loss was 60.0+/-20.5 ml. There was no intraoperative complications and postoperative complications developed in 3 patients (16.7%), including fever in 2 cases (grade II on Clavien) and urinary leakage in 1 patient (grade I on Clavien). Laparoscopic pyeloplasty was ineffective in 1 case (5.4%), according to dynamic scintigraphy. Laparoscopic pyeloplasty is feasible method in case of recurrent UPJ obstruction despite scar tissue in the area of intervention.