Application of minimally invasive pyeloplasty in kidney preservation for the treatment of giant hydronephrosis

Abstract

Objective To evaluate the application of laparoscopic pyeloplasty (LP) and robot assisted laparoscopic pyeloplasty (RALP) in kidney preservation for the treatment of ureteropelvic junction obstruction (UPJO) with giant hydronephrosis. Methods Data of 3 children with UPJO and giant hydronephrosis (>1 000 ml) from August 2015 to July 2016 in the First Affiliated Hospital of Sun Yat-sen University were collected. All patients underwent preoperative nephrostomy and followed with minimally invasive Anderson-Hynes pyeloplasty (2 cases of RALP, 1 case of LP) one month after nephrostomy. All patients were followed up regularly to evaluate the improvement of renal morphology and function. Clinical treatment experiences were analyzed. Results The operation time of pyeloplasty was 180 min, 147 min and 205 min respectively in the three patients. Two cases recovered excellently, one case who underwent RALP appeared anastomotic stenosis and cured with open pyeloplasty. Hydronephrosis alleviated and the postoperative renal cortical thickness, glomerular filtration rate (GFR) and split renal function (SPF) increased significantly compared with preoperative results in all patients. The renal morphology and function improved excellently. Conclusions Minimally invasive pyeloplasty acquires little trauma in treatment of giant hydronephrosis, and the renal morphology and function can also improve excellently if inflammatory stricture is avoided and anastomotic patency is ensured. Key words: Hydronephrosis; Pyeloplasty; Minimally invasive; Kidney preservation; Robot