Determination of success by objective scintigraphic criteria after laparoscopic pyeloplasty

Laparoscopic pyeloplasty (LP) is a minimally invasive technique with high success rates that match open procedures. There are a variety of success definitions. We have defined and reported our success rate by objective renal scintigraphic criteria. We also compare our scintigraphic success with clinical success defined by absence of pain.

We reviewed retrospectively 111 adult cases of laparoscopic pyeloplasties. The Anderson-Hynes technique was used in 98% of cases. nonprimary pyeloplasties represented 12 cases of our series. Renal scintigraphic success rates were defined as: strict (T(1/2) <10 min), nonobstructive (T(1/2) <20 min), and technical success (improved T(1/2)). Of our patients, 83% had renal scintigraphy before and after surgery.

Average operative time was 128 +/- 45 minutes, blood loss was 52 +/- 168 mL, and median postoperative hospital stay was 3 days. After surgery, T(1/2) was decreased by 26 minutes for a median time of 13 minutes. Strict success was achieved in 61% of cases, while nonobstructive success and technical success were achieved in 86% and 93%, respectively. No difference in success was observed between primary and nonprimary cases. Clinical success (absence of symptoms) was achieved in 95% of LPs. We also show that 75% of patients who had obstruction after LP based on scintigraphic criteria were asymptomatic, showing a poor correlation between symptoms and obstruction.

By defining success with renal scintigraphic criteria, we still obtain a high success rate. When using strict criteria, however, the success decreases and might identify patients at risk of late recurrence.