Laparoscopic pyeloplasty: experience with the initial 30 cases.

Abstract

We assessed the intermediate effectiveness of laparoscopic pyeloplasty in the treatment of the obstructed ureteropelvic junction. A total of 30 pyeloplasties was performed for symptomatic ureteropelvic junction obstruction (24 primary and 6 secondary cases). Two separate types of reconstruction were performed, that is dismembered (26 patients) and Y-V (4) pyeloplasty. All patients were followed with excretory urography or diuretic renography. Moreover, factors affecting the learning curve (surgical technique, prior laparoscopic experience and cause of obstruction) were evaluated. A lower pole segmental renal vessel was found at the ureteropelvic junction in 18 patients (60%). Operative time ranged from 2.25 to 8.0 hours (mean 4.5). Postoperative morbidity (mean narcotic requirement 37.3 mg. morphine sulfate, mean hospital stay 3.5 days and convalescence 3 weeks) was minimum. At radiographic followup (mean 16.3 months, range 4 to 73) 97% of the patients demonstrated a patent ureteropelvic junction and resolution of or substantial decrease in hydronephrosis. In the hands of an experienced laparoscopist, outcomes indicate that laparoscopic pyeloplasty shows success similar to that of open pyeloplasty but longer term outcomes must be assessed.