Related Experiment Video
Updated: Jun 19, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Short stay pyeloplasty with transverse dorsal lumbotomy incision: our 10-year experience
Fikret F Onol1, Alpaslan Akbaş, Osman Köse
1Clinic of Urology, Sakarya Training and Research Hospital, Sakarya, Turkey. ffonol@yahoo.com
Insights
The transverse dorsal lumbotomy (TDL) approach offers excellent results for ureteropelvic junction obstruction (UPJO) repair in children, with rapid recovery and no recurrence. This minimally invasive technique is ideal for bilateral cases.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly requiring surgical correction.
- Traditional open surgical approaches can lead to significant morbidity and prolonged recovery.
- Minimally invasive techniques are increasingly sought for pediatric urological conditions.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of a modified transverse dorsal lumbotomy (TDL) approach for pediatric UPJO.
- To assess TDL as a minimally invasive alternative to open pyeloplasty.
- To analyze patient outcomes including operative time, hospital stay, and complication rates.
Main Methods:
- A retrospective review of 59 children who underwent TDL pyeloplasty between 1999 and 2008.
- Data collected included operative details, length of hospital stay, return to activity, and complications.
- Postoperative follow-up involved serial urinalysis, ultrasonography, and renography/urography.
Main Results:
- Median operative time was 78 minutes with a 3-5 cm incision.
- Children experienced rapid recovery, with unrestricted activity within 48 hours and discharge within 2 days (88% of patients).
- No cases of recurrent UPJO were observed during a median follow-up of 56 months.
Conclusions:
- Transverse dorsal lumbotomy (TDL) provides excellent surgical exposure for UPJO repair in children.
- TDL offers a cosmetically favorable scar and a significant advantage in terms of minimal convalescence.
- The approach is particularly beneficial for bilateral UPJO, allowing synchronous repair without patient repositioning.
Objectives:
To review our long-term results with a modified dorsal lumbotomy (DL) approach and evaluate its role as a minimally-invasive alternative for the surgical management of ureteropelvic junction obstruction (UPJO).
Methods:
Fifty-nine consecutive children (42 males, 17 females, median age: 5.7 years) underwent pyeloplasty with transverse DL (TDL) between 1999 and 2008. Kidney stones, solitary kidney, and bilateral UPJ obstruction was present in 6, 3, and 5 children, respectively. Forty-nine and 10 children received stented dismembered pyeloplasty and Y-V plasty, respectively. Information on the duration of surgery, length of hospital stay, length of time to return to unrestricted activity, and per/postoperative complications was recorded. Children were followed up postoperatively with urinalysis and ultrasonography (US) at first month, diuretic renogram or intravenous urography (IVU) or both at sixth month, and yearly thereafter with US and renal scintigraphy for the emergence of recurrent clinical symptoms, deterioration of differential renal function, or increase in hydronephrosis.
Results:
Median operative time was 78 minutes and median incision length ranged between 3 and 5 cm for all age groups. All children tolerated liquid diet within the evening of surgery and returned to unrestricted activity within 48 hours. Eight-eight percent of all patients were discharged within 2 days, and 88% of children operated after 2004 were discharged in less than 30 hours. Recurrent UPJO was not evident in any case with a median follow-up of 56 months.
Conclusions:
TDL provides excellent exposure for UPJO repair with a cosmetically appealing scar while maintaining a minimal convalescence advantage. It is particularly beneficial in bilateral pyeloplasty as synchronous bilateral repair can be performed without repositioning the patient.
