Abstract
ABSTRACTPurpose To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO).Materials and methods 38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative DTPA (diethylene-triamine-pentaacetate) renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. Treatment success was evaluated by a 12 month-postoperative renal scan. Total success was defined as T1/2≤10 minutes while relative success was defined as T1/2between 10 to 20 minutes. Post-operative hydronephrosis and flank pain were also evaluated.Results Mean operating time was 103.16±30 minutes. The mean blood loss was 122.37±73.25mL. The mean postoperative hospital stay was 4.47±0.86 days. No intraoperative complications occurred. 6 out of 38 patients (15.8%) experienced postoperative complications. The success rate was 97.4% for flank pain and 97.4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38 (2.6%) patients, relative success in 2 out of 38 (5.3%) patients and total success in 35 out of 38 (92.1%) of patients.Conclusion Laparoscopic redo-pyeloplasty is a feasible procedure for the treatment of recurrent ureteropelvic junction obstruction (UPJO), with a low rate of post-operative complications and a high success rate in high laparoscopic volume centers.
Highlights
The failure of laparoscopic pyeloplasty can be early or late
A kidney stone was associated to ureteropelvic junction obstruction (UPJO). 24 out of 38 (63.2%) patients performed their first pyeloplasty at other hospitals (14 out of 24 procedures were performed using the retroperitoneal open technique and 10 out of 24 using the laparoscopic transperitoneal technique)
Two patients (5.3%) underwent a retrograde endopyelotomy at other hospitals
Summary
The failure of laparoscopic pyeloplasty can be early or late. The manifestation is often with pain, fever or a worsening of hydronephrosis after removing the ureteral stent. Renal scintigraphic criteria seems to be the best criteria to take into consideration a successful pyeloplasty. About 75% of patients who experienced obstruction after a lapaibju | Laparoscopic management of recurrent UPJO roscopic pyeloplasty based on scintigraphic criteria were asymptomatic, showing a bad correlation between obstruction and symptoms [1]. The patients can have a nonobstructive significant hydronephrosis and a residual atonic pelvis after pyeloplasty. In that case they can exhibit delayed t1/2 in the “indeterminate” or “obstructed” range [2]
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