Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children

Purpose: To examine our experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population. Methods: From November 2001 to June 2009, 112 patients underwent transperitoneal laparoscopic pyeloplasty for the treatment of symptomatic or radiographic UPJO. Data were collected retrospectively. Patients were followed at regular intervals with imaging and symptom assessment. Failure was defined as inability to complete the intended procedure, persistent flank pain, radiographic evidence of obstruction, or the need for definitive adjunctive procedures. Results: Mean patient age was 9.4 years (0.2-20.5 years), and follow-up was available on all 112 patients with a mean duration of 15.3 months (0.6-84.5 months). There was one open conversion in the series. Mean operative time was 254 minutes (102-525 minutes). There was one minor intraoperative complication reported (0.8%). There were 12 (10.8%) postoperative complications; most were relatively minor with complete resolution and without long-term sequelae. Postoperative ultrasonography has been performed in 102 patients, with 99 (97%) patients demonstrating improvement of the UPJO. Three patients (3%) continued to have symptomatic and/or radiographic evidence of obstruction that necessitated the need for adjunctive procedures, which included laser endopyelotomy in 2 patients, and a re-do open pyeloplastiy in 1 patient. Of those cases that were completed laparoscopicaly, the overall success rate was 97.2%. Conclusions: Laparoscopic pyeloplasty for UPJO in the pediatric population is technically challenging; however, with experience, one can expect excellent success rates comparable to open pyeloplasty, with minor complications with reasonable operative times.