Abstract
ABSTRACTObjetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age.Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported.Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results.Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.
Highlights
Pelvic-ureteric junction (PUJ) obstruction is a common problem and the main cause of hydronephrosis in childhood
From June 2015 to December 2017 38 children undergoing Laparoscopic pyeloplasty (LP) due to PUJ obstruction and aged 5 years old or younger were enrolled to this study
PUJ obstruction is a common problem in children
Summary
Pelvic-ureteric junction (PUJ) obstruction is a common problem and the main cause of hydronephrosis in childhood. Treatment has been proposed at younger ages. Open pyeloplasty has long been the gold standard treatment of PUJ obstruction in children. The open approach was described by Anderson-Hynes in 1949 with success rates over 90% [1]. Laparoscopic pyeloplasty (LP) was first performed in adults in 1993 [2]. The approach results are already well established, and it has been the first choice where such technology is available, with advantages of a minimally invasive procedure. The proposed benefits are shorter hospitalization, reduced postoperative pain, early return to daily activities and improved cosmetic appearance, while providing good functional results in a reasonable operative time [3, 4]
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