Preliminary Experience with Laparoscopic Ureteropelvic Junction Release in the Treatment of Ureteropelvic Junction Obstruction

Objective: To review our experience with laparoscopic ureteropelvic junction (UPJ) release in the treatment of UPJ obstruction (UPJO) in adults. Patients and Methods: We retrospectively reviewed 44 consecutive patients who underwent laparoscopic treatment of UPJO at our institution between December 2000 and April 2008. Patient characteristics, perioperative data, intraoperative findings leading to a decision to perform UPJ release, and outcomes were recorded. Mean patient age was 47.4 years (range 20-60 years). Results: UPJ release was performed as definitive treatment in 9 of 47 laparoscopic procedures for UPJO. The obstruction was right-sided in five and left-sided in four patients. Three (33%) patients were previously treated with either balloon dilation or endopyelotomy, or both. Intraoperative findings included (1) significant scarring, inflammation, or fibrosis, (2) adherent bands between a crossing vessel and the UPJ, or (3) obvious constricting periureteral bands. A crossing vessel was observed in seven patients (78%). Mean operative time, estimated blood loss, and length of stay were 370.1 +/- 76.9 minutes, 24.4 +/- 31.3 mL, and 1.4 +/- 0.5 days, respectively. At a mean follow-up of 25.1 +/- 17.3 months, a 78% overall success rate was achieved. UPJ release was most successful in the patients in the "significant scarring, inflammation, or fibrosis'' category (100%). Conclusion: Although pyeloplasty remains the preferred treatment for UPJO, UPJ release can be successful in certain circumstances, particularly when significant scarring, inflammation, or fibrosis appears to be the primary etiology of the obstruction. Further investigation is warranted to help define the specific clinical situations in which UPJ release may be beneficial.