Laparoscopic pyeloplasty, initial experience in the management of UPJO

Laparoscopic pyeloplasty (LP) has emerged in the last 8 years as an alternative to open surgery. We here present the results of our series of patients and evaluate LP in the management of ureteropelvic junction obstruction (UPJO).

Patients with UPJO confirmed by renogram and/or symptoms were offered surgical correction by LP. The risks, alternatives, and novelty of the technique at our centre were explained to obtain informed consent. Patients were assessed pre- and postoperatively and data including operative time, analgesic requirements, time to self care and full activity were recorded. Fifteen patients with a mean age of 38.4 years were recruited in whom 13 successful Anderson Hayes transperitoneal LPs were performed in 12 patients.

Mean operative time was 261 min and blood loss was minimal. Analgesic requirements were also minimal with patients requiring PCA for an average of 1.1 days. Average days to free fluids were 1.5 days and the mean hospital stay was 4.4 days. Average number of days to self care and full activity were 3.2 and 12.2 days, respectively. Patients in employment returned to work after an average of 4.4 weeks, In 9/10 cases with pre-operative loin pain, patients had symptom relief following surgery. Postoperative renogram at 6 months confirmed improved drainage in 12 LP procedures. At a mean follow up of 20 months, 11/12 patients remain symptomatically well.

In this series, LP operative times and outcome closely match those of larger series and the functional results are comparable to open pyeloplasty. We conclude that LP is a suitable first line option for UPJO surgery provided standard laparoscopic equipment and a trained urologist are available.