53 Salvage laparoscopic pyeloplasty

Abstract

Introduction: Greater experience with urological laparoscopy has lead to increasing interest in its use for reconstructive surgery, such as pyeloplasty. We compared the outcomes of primary versus salvage laparoscopic pyeloplasty (LP) in a single surgeon series of 124 LP.Patients and Methods: One hundred and twenty‐four cases of laparoscopic pyeloplasty (LP) were performed, 11 of which followed failed primary treatment at other institutions: balloon dilatation (n = 3); endopyelotomy (n = 3); open pyeloplasty (n = 3); endopyelotomy plus balloon dilatation (n = 1); and open pyeloplasty plus balloon dilatation (n = 1). Nine patients had renal calculi. A four‐port balloon‐dissecting extraperitoneal laparoscopic approach was used in all but one patient who had a horseshoe kidney, necessitating a transperitoneal approach.Results: The operating time was 29 min longer in the secondary pyeloplasty group compared to primary cases (173.3 vs. 144.0 min), but the conversion rate (0% vs. 1.6%) and duration of postoperative hospitalisation (2.5 vs. 2.7 nights) were no greater. The complication rates were 3.6% and 9.1%. The success rates were 98.2% and 90.9% (P = 0.63) at a mean follow‐up of 20.2 and 19.7 months.Conclusion: Extraperitoneal laparoscopic dismembered pyeloplasty is capable of addressing all causes of UPJ obstruction with excellent functional results and low morbidity, and in an operating time similar to that of open pyeloplasty. Secondary LP does not increase hospitalization, conversion or complication rates.