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Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children
Danielle D Sweeney1, Michael C Ost, Francis X Schneck
1Department of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. dsweeney@childrensurology.com
Insights
Laparoscopic pyeloplasty is a successful treatment for pediatric ureteropelvic junction obstruction (UPJO). This minimally invasive approach offers excellent outcomes with a high success rate and manageable complications.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly.
- Surgical correction is often necessary to relieve obstruction and preserve renal function.
- Open pyeloplasty has been the traditional treatment, but minimally invasive options are increasingly explored.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic pyeloplasty in treating pediatric UPJO.
- To assess the learning curve and outcomes with increasing surgical experience.
Main Methods:
- Retrospective review of 112 pediatric patients undergoing transperitoneal laparoscopic pyeloplasty for UPJO (2001-2009).
- Data collection included operative details, complications, and follow-up assessments (imaging and symptoms).
- Success defined by resolution of obstruction and absence of further intervention needs.
Main Results:
- A total of 112 pediatric patients were included, with a mean age of 9.4 years.
- The overall success rate for laparoscopic pyeloplasty was 97.2% after a mean follow-up of 15.3 months.
- Complications were generally minor (10.8% postoperative), with only one conversion to open surgery.
Conclusions:
- Laparoscopic pyeloplasty is a technically demanding but highly successful procedure for pediatric UPJO.
- Outcomes are comparable to open surgery, with the advantages of minimally invasive approaches.
- Experience is crucial for achieving excellent success rates and minimizing complications.
Purpose:
To examine our experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population.
Methods:
From November 2001 to June 2009, 112 patients underwent transperitoneal laparoscopic pyeloplasty for the treatment of symptomatic or radiographic UPJO. Data were collected retrospectively. Patients were followed at regular intervals with imaging and symptom assessment. Failure was defined as inability to complete the intended procedure, persistent flank pain, radiographic evidence of obstruction, or the need for definitive adjunctive procedures.
Results:
Mean patient age was 9.4 years (0.2-20.5 years), and follow-up was available on all 112 patients with a mean duration of 15.3 months (0.6-84.5 months). There was one open conversion in the series. Mean operative time was 254 minutes (102-525 minutes). There was one minor intraoperative complication reported (0.8%). There were 12 (10.8%) postoperative complications; most were relatively minor with complete resolution and without long-term sequelae. Postoperative ultrasonography has been performed in 102 patients, with 99 (97%) patients demonstrating improvement of the UPJO. Three patients (3%) continued to have symptomatic and/or radiographic evidence of obstruction that necessitated the need for adjunctive procedures, which included laser endopyelotomy in 2 patients, and a re-do open pyeloplasty in 1 patient. Of those cases that were completed laparoscopicaly, the overall success rate was 97.2%.
Conclusions:
Laparoscopic pyeloplasty for UPJO in the pediatric population is technically challenging; however, with experience, one can expect excellent success rates comparable to open pyeloplasty, with minor complications with reasonable operative times.
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