Functional outcome after laparoscopic dismembered pyeloplasty in children
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Updated: Jun 18, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Philipp O Szavay1, Tobias Luithle, Guido Seitz
1Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
Insights
Laparoscopic pyeloplasty effectively preserves differential renal function in children with ureteropelvic junction obstruction. Postoperative tracer clearance significantly improves, supporting its role as a gold standard surgical option.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Renal Function Assessment
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of pediatric hydronephrosis.
- Laparoscopic pyeloplasty is increasingly utilized for UPJ obstruction.
- Evaluating functional outcomes is crucial for surgical success.
Purpose of the Study:
- To assess the functional outcomes of laparoscopic dismembered pyeloplasty in children.
- To compare differential renal function (DRF) and tracer clearance before and after surgery.
- To evaluate changes in hydronephrosis grade postoperatively.
Main Methods:
- Retrospective review of 70 children undergoing laparoscopic dismembered pyeloplasty.
- Diuretic renography to measure DRF and tracer clearance pre- and postoperatively (3 and 12 months).
- Ultrasound to assess hydronephrosis grade pre- and postoperatively.
Main Results:
- Laparoscopic pyeloplasty preserved mean DRF without significant difference (P>0.05).
- Significant improvement in tracer clearance was observed postoperatively (P<0.0001).
- Diminished hydronephrosis grade was noted postoperatively, though not statistically significant (P=0.657).
Conclusions:
- Laparoscopic pyeloplasty is effective in preserving DRF, comparable to open surgery.
- Significant improvement in renal function (tracer clearance) supports the efficacy of the procedure.
- Laparoscopic pyeloplasty, with sufficient expertise, may become the gold standard for UPJ obstruction treatment.
Objective:
Laparoscopic or retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction in children has become a routine procedure. The aim of this study was to evaluate functional outcome for patients who had undergone a laparoscopic dismembered pyeloplasty.
Patients And Methods:
Seventy children underwent a laparoscopic dismembered pyeloplasty. Median follow up was 24 months (1-48). We reviewed differential renal function (DRF) and tracer clearance with diuretic renography before as well as 3 and 12 months after operation. Ultrasound was used to determine the grade of hydronephrosis pre- and postoperatively.
Results:
Median age at operation was 20 months (1-178). Median operating time was 140 min (95-220). Mean DRF could be preserved with no significant difference (P>0.05). All patients showed a significant improvement in tracer clearance on diuretic renography postoperatively (P<0.0001). Ultrasound examinations postoperatively showed a diminished grade of hydronephrosis without significance (P=0.657).
Conclusion:
In terms of preservation of DRF the laparoscopic approach is as effective as open surgery. Tracer clearance is significantly improving. Operating times for laparoscopic pyeloplasty are competitive. We conclude that laparoscopic pyeloplasty requires extensive experience in laparoscopic pediatric urology but might replace the open surgical procedure as gold standard in the operative treatment of ureteropelvic junction obstruction.
