Correction Of Ureteropelvic Junction Obstruction Research Articles

Robotic-Assisted Laparoscopic Pyeloplasty in Challenging Cases of Ureteropelvic Junction Obstruction in the Pediatric Population: A Multicenter Review.

Purpose: To report a multi-institutional international experience in performing robotic pyeloplasty for complicated cases of ureteropelvic junction obstruction (UPJO) in the pediatric population and assess feasibility and outcomes. Materials and Methods: Retrospective chart review of all pediatric patients who underwent robotic-assisted laparoscopic pyeloplasty (RALP) for UPJO in challenging cases between 2013 and 2021 was included. Demographics, perioperative surgical data, complications, and results are described. Challenging cases were defined as bilateral UPJO, failure of previous open pyeloplasty (thus re-do cases), correction of UPJO in kidneys with anatomical variations, huge hydronephrosis, and low-weight infants (<6 kg). Results: Over an 8-year period, 36 children (62% males and 38% females) met the inclusion criteria for our study. Fifteen patients underwent RALP for recurrent UPJO; among them, 2 children required simultaneous surgery for renal stones, 3 cases of lower pole UPJO in double collecting system, 3 cases of pelvic and horseshoe kidneys, 10 cases of infants weighing <6 kg, 3 cases of huge hydronephrosis, and 2 cases of bilateral UPJO. The median age and weight were 36 months (interquartile range [IQR] 14-84) and 12 kg (IQR 10-20.5), respectively. All robotic cases were completed successfully with no conversion to an open procedure. The median operative time was 120 minutes (IQR 90-135). The mean length of hospital stay was 2.6 days. Four patients (17%) had postoperative complications-1 ileus (Clavien-Dindo grade [CDG] I) and 3 urinary tract infections (CDG II). No CDG III or higher complication was encountered. At a median follow-up of 36 months, the success rate was 95% with 1 patient requiring another re-do procedure due to recurrent obstruction. Conclusions: Our data suggest that RALP is safe and effective even for challenging cases of UPJO in children.

Postnatal Calyceal-to-Parenchymal Ratio: A Promising Predictor for Surgical Correction of Ureteropelvic Junction Obstruction in Newborns

Postnatal Calyceal-to-Parenchymal Ratio: A Promising Predictor for Surgical Correction of Ureteropelvic Junction Obstruction in Newborns

Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques.

Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Feb 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Safety and Efficacy of Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair in Infants under 1 Year of Age Even as robotic pediatric urological procedures proliferated, open pyeloplasty continued to be standard of care in infants. The robotic assisted laparoscopic approach was ideal for older children, allowing for meticulous anastomotic repair of the ureteropelvic junction while decreasing recovery times and postoperative pain levels. For open infant pyeloplasty, multiple sites had already demonstrated short length of stay and pain management without opioids. Additionally, because of concerns of the decreased instrument working space in small infants, initial published studies on pediatric robotic pyeloplasty were limited to children weighing more than 10 kg. Increasingly, pediatric centers are offering a robot-assisted laparoscopic approach for these smaller infants as well. In this issue of The Journal, Rague et al (page 432) from Chicago compare outcomes from robotic assisted laparoscopic to open pyeloplasty in infants younger than 1 year of age and less than 10 kg.1 In this retrospective study, pyeloplasty was performed by robotic assisted laparoscopic approach in 83 infants and open approach in 121. Infants in the robotic group tended to be older and to weigh more. The authors did not demonstrate a significant difference in length of stay, postoperative radiographic improvement, 30-day complication rate or need for reoperative pyeloplasty. Currently, the robotic procedures required more hospital resources. The robotic procedures had longer operative times, and approximately a third of the robotic procedures had 2 attending co-surgeons. The dissemination of robotics has changed pediatric urology fellowship training much like it has changed general urology residency. The authors report that the robot-assisted laparoscopic approach has been the preferred method for correction of ureteropelvic junction obstruction in infants at their institution since 2017—so much so that no open infant pyeloplasty was performed from January to June 2020. Certainly, the needs of urology learners are ever changing, and pediatric urology educators should be vigilant. This study highlights that trainees may have limited exposure to open infant pyeloplasty in the near future unless it remains an educational priority. Reference 1. : Safety and efficacy of robot-assisted laparoscopic pyeloplasty compared to open repair in infants under 1 year of age. J Urol 2022; 207: 432. Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue 2February 2022Page: 261-261 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy T. Tanaka More articles by this author Expand All Advertisement Advertisement Loading ...

Subadventitial dismembered pyeloureteroplasty – new surgical technique for correction of uretero-pelvic junction stenosis

Objective: Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%. Main insufficient feature of dismembered pyeloureteroplasty is interfering ureteral blood supply, which creates the prerequisites for the deterioration of the regeneration of the ureter and the possibility of developing restenosis. Methods: We offered and applied the new method – subadventitial resection of ureteropelvic junction (UPJ) to prevent damage to vessels of the distal part of pelvis and proximal part of the ureter. The protection of blood supply in this area should improve anastomosis regeneration and prevent fibrotic changes for long time, simultaneously providing better condition for the kinetic ability of the ureter. Results: Retrospective analysis of 106 patients with hydronephrosis, whom performed 108 open dismembered pyeloplasty (two patients were operated bilaterally) with subadventitial resection of UPJ from 1998-2020 years with a mean follow-up of 36 month shows that this technique has advantages over analogues. Conclusion: Our 22 years of experience shows that the technique of subadventitial resection of the ureter, allows us to save the ureteral blood circulation and thus creates conditions for better regeneration of the anastomosis and prevent later complications of dismembered pyelouretereroplasty.

Uretero-duodenal Fistula as a Result from Ureteropelvic Junction Obstruction Correction: Case Report

Uretero-duodenal fistula is an uncommon complication in urology. The cause of fistula have been reported as ureteral calculi, iatrogenic injury, trauma and malignancy. The gold standard treatment of uretero-duodenal fistula remains controversial. The most common management is nephrectomy and primary closure of fistula. We report a case of 67 yearold man with uretero-duodenal fistula after laparoscopic correction of ureteropelvic junction obstruction. In the era of minimal invasive management, we decided to use endoscopic and conservative treatment. The definitive treatment will be reconsidered if conservative treatment fails. We will discuss the steps of management and follow-up for this patient.

Comparison of 30-day postoperative outcomes of open and minimally invasive pyeloplasty utilizing the prospective National Surgical Quality Improvement Program-Pediatric database

Open pyeloplasty (OP) has traditionally been the standard for the operative management of ureteropelvic junction obstruction in children. With advances in minimally invasive pyeloplasty (MIP) techniques, it is quickly becoming a popular alternative in both adult and pediatric population. To evaluate the differences in outcomes between MIPand OPfor the surgical correction of ureteropelvic junction obstruction in children. Data were obtained from the pediatric National Surgical Quality Improvement Program 2012-2017. We identified 1280 patients who underwent MIP and 1190 patients who underwent OP between 2012 and 2017. Propensity score matching was utilized to adjust for baseline differences. Univariate and multivariable regression were performed to assess odds of complications and procedure-related readmission. Patients who underwent OP had a significantly decreased operative time (192.42 vs 142.00min, p<0.001) compared to MIP. There was no significant difference in the rates of overall peri-operative complications (3.7% [MIP] vs 2.4% [OP] p=0.397). On multivariable analysis, patients undergoing OP had a lower risk of procedure-related readmission (odds ratio [OR] 0.404, 95% confidence interval [CI] 0.157-0.951, p=0.046) than MIP. In a multivariable linear regression model, the risk of having any postoperative complication, regardless of surgical approach, decreased with increasing patient age (OR 0.945, 95% CI 0.893-0.996, p=0.037). Although recent small, retrospective institutional studies have found decreased hospitalization time of MIP as compared to OP, in our large prospective database, we found no such association. While some studies suggest a higher rate of wound complications in the OP group, this was not reproduced in our study as well. MIP was, in fact, associated with higher rate of readmissions as compared to the OP group, which may act as a surrogate of long-term complications in these patients. MIP offers an alternative to OP in the pediatric population with similar rates of peri-operative complications. However, our study shows decreased odds of procedure-related readmission in OP, which may serve as a surrogate for less postoperative complications in these patients.

Early Surgical Correction of Ureteropelvic Junction Obstruction

Early Surgical Correction of Ureteropelvic Junction Obstruction

Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database

The surgical correction of ureteropelvic junction obstruction (UPJO) is indicated to prevent progression to chronic renal insufficiency. Minimally invasive surgery (MIS) has become increasingly popular as an approach to UPJO correction. We compared the perioperative outcomes between minimally invasive (MIP) and open pyeloplasty (OP) in the adult population. The current study was performed using the American College of Surgeons National Surgical Quality Improvement Program. Patients were identified using Current Procedural Terminology codes for pyeloplasty between 2005 and 2012, and were stratified according to either MIS or open approach. Patients with a diagnosis of malignant neoplasm of the kidney were excluded. Following exclusions, 593 patients remained for analysis. Primary outcomes of interest were overall perioperative complications, need for transfusions, re-intervention rate, prolonged operation time (pOT), prolonged length of stay (pLOS), readmission and mortality within 30 days of surgery. Multivariable logistic regression analyses were performed to examine the association between preoperative outcomes and surgical approach. In this study, 423 (71.3 %) patients underwent MIP and 170 (28.7 %) underwent OP. Patients who underwent MIP had a decreased risk of wound [Odds ratio (OR) 0.06, p < 0.009] and overall complications (OR 0.21, p < 0.001), transfusions (OR 0.04, p = 0.004) and pLOS [pLOS (OR 0.08, p < 0.001)]. Conversely, MIP was associated with an increased likelihood of pOT (OR 2.26, p = 0.002). Adults with UPJO undergoing MIP have a lower risk of overall complications, transfusions and pLOS compared to OP. Further studies are needed to determine whether these benefits offset the increase in expenditures, related to longer operative time and costs of disposables.

National Trends in Followup Imaging after Pyeloplasty in Children in the United States

Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty. Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns. We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression. Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.

Correction of Ureteropelvic Junction Obstruction in Children: National Trends and Comparative Effectiveness in Operative Outcomes

To assess the national trends and comparative effectiveness of the various treatments for pediatric ureteropelvic junction obstruction (UPJO). Within the Nationwide Inpatient Sample, a weighted estimate of 35,275 pediatric patients (<19 years; 1998-2010) with UPJO underwent open pyeloplasty (OP), laparoscopic pyeloplasty (LP), robot-assisted pyeloplasty (RP, ≥October 2008) or endopyelotomy (EP). National trends in utilization and comparative effectiveness were evaluated. Minimally invasive pyeloplasty (RP+LP, MIP) utilization began to increase in 2007; MIP accounted for 16.9% of cases (2008-2010). EP accounted for 1.4% of all cases from 1998 to 2010. On individual multivariate models (relative to OP): (a) no significant differences were noted between groups for intraoperative complications; (b) RP and LP had equivalent risks of postoperative complications developing (vs OP), but EP had a significantly higher risk of postoperative complications; (c) RP and EP had significantly higher risks of necessitating transfusions; (d) RP, LP, and EP had higher overall risks of greater hospital charges; (e) RP had a lower risk of greater length of stay, while EP had a higher risk (LP and OP were equivalent). OP continues to be the predominant treatment for patients with UPJO. RP was the most common MIP modality in every age group. Compared with OP patients, RP patients had equivalent risk for intraoperative and postoperative complications, lower risk for greater length-of-stay, but higher risks for transfusions and greater hospital charges. LP patients had higher overall hospital charges, but no mitigating benefits relative to OP. EP fared poorly on most outcomes.

External extension of double-J ureteral stent during pyeloplasty: inexpensive stent and non-cystoscopic removal

The purpose of the study is to describe our experience with the application of externalized double-J ureteral stent (DJUS) during pyeloplasty for correction of ureteropelvic junction obstruction (UPJO) in order to avoid cystoscopy for stent removal. Pyeloplasty was performed in 523 infants with UPJO using miniature pyeloplasty technique. After removing the obstructed segment, a 3-Fr. DJUS was placed into the ureter. In order to avoid cystoscopy for the removal of the stent, a feeding tube was passed through the skin and renal pelvis via a separate stab incision, connected to the DJUS and secured to the external body surface (skin), and the pyeloplasty was completed. The feeding tube along with the stent was removed after 3-4 weeks, respectively. Postoperative follow-up visits were performed 1, 3, and 6 months after the procedure. The mean operative time was 49 min (range 41-79). Patients were discharged after 17 ± 2 h (mean ± SD). No patient experienced bladder spasm or anticholinergic administration. Forty-four patients (8.4 %) experienced minor complications including non-febrile urinary tract infections and mild hematuria. No major complication including urinoma, leakage, and stent migration or displacement was observed during the follow-up period. Stent removal was tolerated by 99.8 % of patients in an outpatient setting with minimal discomfort without performing cystoscopy. Using external DJUS along with a pyelocutaneous stent extension during pyeloplasty is a safe, feasible, and beneficial technique. This technique resulted in high success rate with minimal cost and no renal injury. The non-cystoscopic stent removal and elimination of urethral catheterization following pyeloplasty are the other advantages of this technique.

534 Correction of ureteropelvic junction obstruction in children: National trends and comparative effectiveness in operative outcomes

534 Correction of ureteropelvic junction obstruction in children: National trends and comparative effectiveness in operative outcomes

462 THE CORRELATION OF PLASMA RENIN ACTIVITY WITH RENAL BIOPSY IN PEDIATRIC URTEROPELVIC-JUNCTION OBSTRUCTION

INTRODUCTION AND OBJECTIVES: Plasma renin activity (PRA) has been known to be increased in urinary tract obstruction to compensate decreased local renal blood flow. In pediatric ureteropelvic-junction obstruction (UPJO), PRA has been reported to be increased than control and decreased after surgical correction of UPJO. We compared PRA with the histologic change of renal cortex to analyze the clinical meaning of PRA in pediatric UPJO patients. METHODS: We analyzed 42 consecutive pediatric patients who had been diagnosed with UPJO and undergone pyeloplasty or simple nephrectomy between March 2011 and October 2011. Age at operation, differential renal function (DRF) on diuretric renogram, PRA, and renal histologic change were analyzed. In all patients undergone pyeloplasty, kidney needle biopsies were performed simultaneously. When there was interstitial fibrosis or glomerulosclerosis in renal cortex, it was defined as unfavorable histology. RESULTS: Median age at operation was 5.4 (IQR: 3.3-12.5) months. Pyeloplasty was performed in 40 patients and laparoscopic simple nephrectomy was in 2 patients. Renal cortical histology showed unfavorable histology in 12 patients (28.6%) (Table 1). Gender, laterality, age at operation, blood pressure, serum creatinine, glomerular filtration rate showed no significant difference. Preoperative DRF and PRA were significantly higher in favorable histologic group. CONCLUSIONS: Preoperative DRF and PRA reflected renal histologic change in pediatric UPJO patients. In UPJO, higher PRA was correlated with higher renal function and that could be considered in the management of UPJO patients.

Stentless pediatric robotic pyeloplasty

Open dismembered pyeloplasty remains the standard of care for the correction of ureteropelvic junction obstruction in children. We describe our experience with a tubeless, stentless pediatric robotic pyeloplasty technique. Between October 2008 and September 2009, 12 consecutive children underwent robotic dismembered pyeloplasty. Ureteral stents or nephrostomy tubes were not used. Operative time, hospital stay, days of Jackson-Pratt drainage, and complications were analyzed. Postoperative renal ultrasonography was obtained at 4-6 weeks after surgery. The mean patient age was 9.1 years (3.5-16). The mean operative and console times were 178 (122-250) and 129 (96-193) minutes, respectively. The Jackson-Pratt drain was removed after a mean of 1.8 days (1-4). The mean hospital stay was 2.4 days (1-4.5). There were no complications. Mean follow up was 16 months (12-24 months). All patients had complete resolution of symptoms. Hydronephrosis either completely resolved or significantly decreased in all cases. In cases without complete resolution of hydronephrosis, 99m Tc-MAG-3 diuretic renography showed preservation of renal function without obstruction. Robot-assisted laparoscopic pyeloplasty can be safely performed without internal indwelling stent drainage. In children, this avoids the need for additional anesthesia and stent-related morbidity.

Urinary Proteome Analysis at 5-Year Followup of Patients With Nonoperated Ureteropelvic Junction Obstruction Suggests Ongoing Kidney Remodeling

Severe ureteropelvic junction obstruction is treated surgically. However, for milder cases most clinical teams adopt a watchful waiting approach and only operate in the presence of significant decline of renal function combined with severe hydronephrosis. Little is known about the long-term consequences of ureteropelvic junction obstruction. Using capillary electrophoresis coupled with mass spectrometry, we analyzed the urinary proteome of 42 patients with ureteropelvic junction obstruction 5 years postoperatively or 5 years following spontaneous resolution. At 5-year followup urinary proteomes were similar between patients with early surgical correction of ureteropelvic junction obstruction and age matched controls. In contrast, urinary proteomes differed significantly between conservatively followed patients and controls. Analyses of the proteomic differences suggested ongoing renal or ureteral remodeling in the conservatively followed patients that was not visible clinically. Long-term followup studies are warranted in patients with ureteropelvic junction obstruction, especially those followed conservatively, to determine whether the observed changes in the urinary proteomes become clinically relevant at a later stage.

Comparison of Robot-assisted Versus Conventional Laparoscopic Transperitoneal Pyeloplasty for Patients With Ureteropelvic Junction Obstruction: A Single-center Study

To compare conventional laparoscopic pyeloplasty (C-LPP) and robotic-assisted laparoscopic pyeloplasty (RA-LPP), which are both used for correction of ureteropelvic junction obstruction. Robotic assistance may further expedite dissection and reconstruction; however it is unclear whether this has an impact on results. Between 1999 and 2009, 172 conventional or robotic-assisted transperitoneal laparoscopic pyeloplasties were performed by 2 surgeons. Data were obtained from our prospective database, patient charts, and radiographic reports. Statistical analysis was performed for the groups. A total of 98 patients underwent R-LPP, and 74 underwent C-LPP. Mean age, body mass index, and gender distribution were similar for the groups. Of the patients, 22 (12.8%) had secondary ureteropelvic junction obstruction. Operative time in minutes was 189.3 ± 62 for RA-LPP, and 186.6 ± 69 for C-LPP (P = .69) respectively. Intraoperative and postoperative complication rates for RA-LPP and C-LPP were 1%, 5.1% and 0, 2.7% (P = .83 and .85) respectively. There was no significant difference in mean suturing time: 48.3 ± 30 and 60 ± 46 (P = .30) for RA-LPP and C-LPP, respectively. Long-term follow up (minimum 6 months; available for 136 patients) showed 93.4% and 95% radiographic success rate based upon diuretic scintirenography for RA-LPP and C-LPP respectively. Operative time, perioperative outcome and success rates are similar for C-LPP and RA-LPP. Mean suturing time for RA-LPP was shorter; however, there was no significant time difference in total operative time. Complications for both procedures are infrequent. Success rates, as measured by diuretic scintirenography, are high for the 2 procedures.

Minimally-invasive correction of ureteropelvic junction obstruction: do retrograde endo-incision techniques still have a role in the era of laparoscopic pyeloplasty?

This study was designed to review the long-term results and complications of the two techniques of retrograde endopyelotomy; ureteroscopic holmium laser endopyelotomy versus Acucise endopyelotomy. The results were then compared with the laparoscopic pyeloplasty results from a recent publication. : The study was conducted retrospectively from January 2004 to July 2007. Seventy-two patients with ureteropelvic junction obstruction (UPJO) underwent retrograde endopyelotomy using either ureteroscopic laser endoincision (42 patients) or fluoroscopic guided hot-wire balloon (Acucise) endoincision (30 patients). Preoperative radiological assessment included intravenous pyelogram (IVP), helical computerized tomography and diuretic renography. The follow-up period ranged from 12 to 42 months. Subjective success was guided by the change in the preoperative flank pain while objective success on radiological evaluation was documented by either nonobstructed curve of diuretic renogram and/or T1/2 less than 10 min. The mean patient age was 42.6 ± 7.5 years for the laser group and 39.2 ± 15.1 years for the Acucise group (p = 0.24). The operative time was 66.8 ± 22.2 min in the laser group and 59.8 ± 20.3 min in the Acucise group (p = 0.84). By objective standards (renal scan), a total of 56 (77.8%) cases were successful (nonobstructed curve). This number included 34 cases in the laser group (80.9%) and 22 cases in the Acucise group (73.3%) (p = 0.2). Overall 16 failure cases were evident clinically within 1 year of the procedure (eight cases in each group). Most of the failure cases (13/16) presented with clinical obstructive symptoms during the early follow-up period (within 3 months postoperatively) and were then confirmed radiologically (six cases in the laser group and seven cases in the Acucise group) while only three patients had failures at 6, 9 and 11 months postoperatively. There was no statistically significant difference as regards intra-operative complications between the two groups (p = 0.4). Intra-operative bleeding was seen in three cases in the Acucise group while postoperatively it was reported in one case. The retrograde endopyelotomy approach is safe and effective for the treatment of patients with UPJO. Both ureteroscopic laser and the hot-wire balloon (Acucise) techniques have an important role in the management of UPJO, especially in secondary cases, and they provide comparable long-term objective and subjective outcomes. Laparoscopic pyeloplasty provides far better results but with higher costs, and requires well-equipped centers and involves a long learning curve.

Comparison of Flank, Dorsal Lumbotomy and Laparoscopic Approaches for Dismembered Pyeloplasty in Children Older Than 3 Years With Ureteropelvic Junction Obstruction

Selecting a surgical approach for correction of ureteropelvic junction obstruction in children is mostly driven by surgeon preference, and includes laparoscopy, flank incision and dorsal lumbotomy. Comparative analyses focusing on operative time, hospital stay and complications are lacking. We retrospectively reviewed the charts of 41 consecutive patients older than 3 years who underwent laparoscopic pyeloplasty by a single surgeon between 2005 and 2008. We compared these cases to 67 age matched cases managed by flank incision (42) or dorsal lumbotomy (25). We evaluated age at surgery, operative time, performance of retrograde pyelogram, length of hospitalization and complication/failure rates. Mean patient age was 7.3 to 8.1 years. Mean operative time was significantly longer for laparoscopy (178 minutes) compared to flank incision (144) and dorsal lumbotomy (148, p = 0.01). Mean hospital stay was significantly shorter for laparoscopy (2.3 days) compared to flank incision (3.6) and dorsal lumbotomy (3.3, p = 0.01). Complications occurred in 4 laparoscopic, 2 flank incision and 2 dorsal lumbotomy procedures. Patients who underwent laparoscopic pyeloplasty had a significantly shorter mean followup (28 months) compared to flank incision (49) and dorsal lumbotomy (47, p = 0.02). Overall complication rates were not significantly different for the 3 pyeloplasty approaches. For the evaluated outcomes our data do not favor one particular surgical access over others in children older than 3 years.

UP-2.107: Retroperitoneal Laparoscopic Dismembered Pyeloplasty: Also Suitable for an Infant?

Experience with retroperitoneal laparoscopic dismembered pyeloplasty for the correction of ureteropelvic junction obstruction is extremely limited in infants. We review our experience with this technique in both children and infants to evaluate its role in the latter group.