The Laparoscopic Management of the Ureteropelvic Junction Obstruction: Our Initial Experience

Abstract

Objective: Higher morbidity rates, extensive scar tissue formation and longer hospitalization periods of the standard open surgical methods for ureteropelvic obstruction has led to acceleration of minimal invasive techniques. Success rate and clinical outcomes of laparoscopic pyeloplasty has become comparable with open surgery. Purpose: The aim was to evaluate the clinical results and complications of transperitoneal laparoscopic pyeloplasty in ureteropelvic obstruction. Material and Methods: Thirty-three patients with ureteropelvic obstruction were enrolled into this study. Eighteen patients underwent Anderson-Hynes dismembered Pyeloplasty and 15 underwent Y-V plasty. Patients were followed-up at postoperative 3., 6. months and then yearly. Partial or total relief of symptoms and improvement in diuretic renogram were accepted as success. Results: Median age was 34.5±15.5(13-74) years, number of males were 13 (39.4%) and females were 20 (60.6%). Median Body Mass Index (BMI) was 25.3±15.4(18.5-33.4). Eight were asymptomatic, and 23 had intermittent pain, preoperatively. Fourteen cases had left ureteropelvic obstruction (42.4%) and 19 had in the right kidney . Intraoperatively 19 cases had aberrant vessel. Mean surgery time was 127.9±38.9 (68-245) minutes, median anastomosis time was 20.8±7.3 (8-39) minutes. Median blood loss was 57.1±28.3 (20-150) mL, median postoperative drainage time was 2.6±1.1 (2-7) days. Only one had prolonged ileus and peritoneal irritation findings. Median narcotic and nonnarcotic requirements were 21.5±4.8 (15-30) and 132.6±37.2 (75-200) mg/day, respectively. Median follow-up period was 35.1±13.6 (11-59) months. Conclusions: Laparoscopic pyeloplasty, is minimally invasive and reliable technique replaces open pyeloplasty in many institutions. Shorter hospitalization, lower postoperative morbidity rates, better cosmetic results and higher success rates can be easily achieved..