834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY Aditya Bagrodia, Brian Harrow, Ephrem Olweny, Stephen Faddegon, Jeffrey Cadeddu, and Jeffrey Gahan Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Brian HarrowBrian Harrow Dallas, TX More articles by this author , Ephrem OlwenyEphrem Olweny New Brunswick, NJ More articles by this author , Stephen FaddegonStephen Faddegon Dallas, TX More articles by this author , Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author , and Jeffrey GahanJeffrey Gahan Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcomes following laparoendoscopic single-site (LESS) pyeloplasty are limited to small cohorts with short-term follow up. The purpose of this study is to evaluate intermediate-term clinical and renal function outcomes of robotic LESS (R-LESS) and conventional LESS (C-LESS) pyeloplasty using diuretic renal scans and estimated glomerular filtration rate (eGFR). METHODS Consecutive patients presenting with ureteropelvic junction obstruction (UPJO) were evaluated by a single surgeon. Diagnosis of UPJO in each case was confirmed radiographically with abdominal computed tomography and diuretic renography. Radiographic obstruction (defined as T1/2 >20 min) was seen in 65% of patients at presentation. All patients who underwent robotic LESS (R-LESS) or conventional LESS (C-LESS) pyeloplasty were entered into a prospectively maintained database. Patient demographics, clinical, perioperative, and postoperative renal function outcomes were recorded. Double-J stents were removed after 4-6 weeks. Postoperative diuretic renography was performed approximately 6 weeks after stent removal, then at 6 months, and yearly thereafter. Clinical (symptomatic response) and radiographic outcomes were documented in each case. RESULTS Fifty-three patients underwent LESS pyeloplasty by a single surgeon from October 2007 to July 2012 (31 C-LESS: 22 R-LESS). Mean follow-up was 12.1 months. Mean operative time and mean blood loss were 202 minutes and 35 ml, respectively. Median hospital stay was 2.0 days. Conversion to open operations occurred in 4 LESS surgeries for failure to progress (7.8%). No intraoperative complications occurred. Postoperative complications occurred with 11 patients (21%). Of these, 9 were > Clavien Grade 3, 7 of which occurred in the C-LESS group. Symptomatic resolution was achieved in 49/51 cases (96.1%). Renal T½ improved in 95.5% of patients. Postoperative split renal function and eGFR improved in 89% and 79% of cases respectively, but were not statistically different from preoperative values. Diuretic renal scans performed at an average of 10.3 months following stent removal indicated radiographic resolution of obstruction (T1/2 ≤ 20 min) in 41/44 cases (93.2%) for the cohort. Paired differences in preoperative and postoperative T1/2 were statistically significant at p<0.01 for the overall cohort. CONCLUSIONS LESS pyeloplasty, when performed robotically or laparoscopically, is safe and efficacious. Both approaches provide excellent intermediate-term outcomes in terms of symptomatic relief and radiographic resolution of obstruction. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e342 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Brian Harrow Dallas, TX More articles by this author Ephrem Olweny New Brunswick, NJ More articles by this author Stephen Faddegon Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Jeffrey Gahan Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...