PD40-05 EVALUATION OF LAPAROSCOPIC PYELOPLASTY AS AN ALTERNATIVE TO NEPHRECTOMY IN ADULTS WITH POORLY FUNCTIONING KIDNEYS DUE TO URETEROPELVIC OBSTRUCTION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-05 EVALUATION OF LAPAROSCOPIC PYELOPLASTY AS AN ALTERNATIVE TO NEPHRECTOMY IN ADULTS WITH POORLY FUNCTIONING KIDNEYS DUE TO URETEROPELVIC OBSTRUCTION Bruno Nascimento, Eduardo Miranda, Victor Srougi, Marco Arap, Hiury Andrade, Anuar Mitre, Rodolfo Bandeira, Miguel Srougi, and Ricardo Duarte Bruno NascimentoBruno Nascimento More articles by this author , Eduardo MirandaEduardo Miranda More articles by this author , Victor SrougiVictor Srougi More articles by this author , Marco ArapMarco Arap More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Anuar MitreAnuar Mitre More articles by this author , Rodolfo BandeiraRodolfo Bandeira More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Ricardo DuarteRicardo Duarte More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic pyeloplasty has been considered the gold-standard treatment for adults with ureteropelvic junction obstruction (UPJO). Likewise, it is well established in adults that a symptomatic non-functioning renal unit should be removed. This study aimed to evaluate safety, kidney function recovery and symptoms improvement after laparoscopic pyeloplasty in adults with poorly functioning kidneys due to UPJO. METHODS Retrospective data analysis from August 2008 to November 2015, from a prospectively maintained database, was performed. Patients with poorly functioning kidney who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty were included. In one patient, the retroperitoneal approach was preferred due to multiple previous abdominal surgeries. Poor function was defined as a split renal function of ≤ 15% in renal scintigraphy with Tc-99m DMSA. Pre and postoperative data were compared regarding differential renal function (DRF) and symptoms. Success was defined as split renal function stabilization (absolute variation of less than 5% in renal scintigraphy) and symptoms improvement. Outcome (renal function stabilization, intra and pos-op complications and symptoms) was further compared to a similar group of patients who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty in normal functioning renal units. RESULTS We identified 167 patients who underwent laparoscopic pyeloplasty in our service. From those, 14 patients had poor renal function, with a mean age of 37 years (23 - 60 years). No major intra or post-operative complications were seen. At a mean follow up of 21.2 months (4-53 m) all patients reported symptoms improvement, no cases of recurrent pyelonephritis or stone formation was seen. Until this date, no patient needed further surgical treatment as re-pyeloplasty, endoscopic treatment or nephrectomy. Complete symptom resolution was seen in 10 patients (71%). One patient, despite showing complete symptom resolution, had decreased postoperative DRF in renal scintigraphy. Overall success rate was 92.8% (13/14). Split renal function remained stable in 11 patients (78,6%), considerably decreased in 1 (7.1%) and considerably increased in 2 (14.3%) patients. Renal function stabilization, intra and post-operative complications were statically similar (p>0.05) when compared to patients with normal functioning renal units who underwent the same procedure. No patient with normal functions renal units showed improvement in DRF measured with Tc-99m DMSA. CONCLUSIONS Laparoscopic pyeloplasty is an alternative to nephrectomy in adults with poorly functioning kidneys due to UPJO, enabling good symptom control with possible considerable improvement in renal function. In this study, laparoscopic pyeloplasty in this of patients showed similar outcomes and success rates to those presented by patients with normal functioning renal units. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e937 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bruno Nascimento More articles by this author Eduardo Miranda More articles by this author Victor Srougi More articles by this author Marco Arap More articles by this author Hiury Andrade More articles by this author Anuar Mitre More articles by this author Rodolfo Bandeira More articles by this author Miguel Srougi More articles by this author Ricardo Duarte More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...