Laparoscopic pyeloplasty: evaluation of 27 cases

Objective: Laparoscopic pyeloplasty which has become popular in recent years is the standard treatment of adult ureteropelvic junction obstruction in our clinic. We presented our experience with laparoscopic pyeloplasty. Materials and methods: Laparoscopic pyeloplasty was performed in 27 patients (13 males, 14 females; mean age 32.5 years; range 11 to 70 years) for ureteropelvic junction obstruction, using transperitoneal approach in 26 cases and retroperitoneal approach in one case. Twenty-five patients underwent dismembered pyeloplasty and two patients underwent nondismembered Foley's Y-V pyeloplasty. An antegrade stent was placed in 18 patients, six patients were operated on without stenting, and stent placement failed in two patients. Evaluations were made by intravenous pyelography at three months and by diuretic renography (n= 18) at six months, together with a detailed pain questionnaire. The mean follow-up was 7.9 months (range 3 to 22 months). Results: The mean operation time was 137 min (range 70 to 126 min), being 170, 132, and 120 minutes in the first 10, second 10, and last seven patients, respectively (p= 0.021). The mean perioperative blood loss was 36 ml. The drainage tube was removed after a mean of 2.1 days. The mean ambulation and oral intake times were 10 hours and 13.4 hours, respectively. The mean length of stay was 4 days (range 3 to 10 days). Drainage continued beyond three days in four patients. No postoperative complications occurred. Pain disappeared in all patients but one (3.7%) who also had significant relief. Intravenous pyelography showed radiologic improvement in 22 patients while findings of five patients remained unchanged. Diuretic renography showed no obstruction in 13 patients. Conclusion: Laparoscopic pyeloplasty is the new standard of repair in adult patients with ureteropelvic junction obstruction, with comparable results to open surgery.