Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction after failed open surgery

Laparoscopic pyeloplasty has been accepted as a helpful option for the treatment of primary ureteropelvic junction (UPJ) obstruction. We report the results of laparoscopic pyeloplasty in cases with secondary UPJ obstruction after failed open pyeloplasty.

Between September 2003 and March 2006, 18 patients with secondary UPJ obstruction secondary to failed open surgery who had undergone laparoscopic pyeloplasty using different techniques were enrolled in this study. The mean age and male-to-female ratio were 29.8 years (range 5-65 years) and 14: 4, respectively. Pain, fever, duration of the operation, changes in renal function, and rate of complications were reviewed.

The mean operation time and average hospital stay were 254 +/- 82 minutes and 7.2 days (range 3-12 days), respectively. The mean follow-up was 14.1 months (range 4-25.5 months). No intraoperative complication occurred. Flank pain, urinary-tract infection, and severe hydronephrosis decreased from 88.9% to 22.2%, 33.3% to 0, and 83.3% to 16.6%, respectively. After laparoscopic pyeloplasty, 100% of patients had improvement in renal function. The number of patients with >50% washout on the DTPA scan 10 and 20 minutes after furosemide injection were 0 and 2 before the operation and 5 and 12 after the operation (27.8% and 62.5% increment, respectively).

Laparoscopic pyeloplasty can be used with acceptable success rate in secondary UPJ obstruction in patients with previous open pyeloplasty.