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Published on: July 8, 2025
Retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting in children
Jianhua Yu1, Zhonghua Wu, Youming Xu
1Department of Urology, Hubei Provincial Corps Hospital, Chinese People's Armed Police Forces, Wuhan, HuBei, China.
Insights
Retroperitoneal laparoscopic dismembered pyeloplasty is a safe and effective treatment for pediatric pelvi-ureteric junction obstruction. This minimally invasive approach offers good outcomes with low complication rates in children aged 3 and older.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common cause of hydronephrosis in children.
- Open pyeloplasty has been the traditional treatment, but minimally invasive alternatives are increasingly sought.
Purpose of the Study:
- To evaluate the feasibility and efficacy of retroperitoneal laparoscopic dismembered pyeloplasty in pediatric patients.
- To assess outcomes, operative time, and complication rates associated with this technique.
Main Methods:
- Retrospective review of 38 children (mean age 8.3 years) who underwent retroperitoneal laparoscopic dismembered pyeloplasty between March 2007 and December 2009.
- A specialized technique involving ureteric catheter and JJ stent placement was utilized.
- All procedures were performed retroperitoneally, with one conversion to open surgery.
Main Results:
- The retroperitoneal laparoscopic approach was successful in 37 out of 38 patients.
- Mean operative time was 162 minutes, decreasing with surgical experience.
- Mean hospital stay was 4 days, with satisfactory drainage and reduced hydronephrosis observed in all patients post-operatively.
Conclusions:
- Retroperitoneal laparoscopic dismembered pyeloplasty is a viable and effective alternative to open surgery for pediatric PUJ obstruction.
- The procedure demonstrates a minimal complication rate in children aged 3 and above.
- Successful implementation requires experienced laparoscopic surgeons.
Objective:
• To report our experience with retroperitoneal laparoscopic dismembered pyeloplasty for pelvi-ureteric junction (PUJ) obstruction in children.
Patients And Methods:
• Between March 2007 and December 2009, 38 children with PUJ obstruction (mean age 8.3 years, range 3-14) underwent retroperitoneal laparoscopic dismembered pyeloplasty. • A ureteric catheter was inserted into the mid-ureter cystoscopically. During pyeloplasty, the proximal end of the ureteric catheter was extracorporeally sutured to the distal end of the JJ stent with silk. • The ureteric catheter was then pulled down and the stent was pulled antegrade into the ureter and bladder.
Results:
• The approach was retroperitoneal in all patients except one who required open conversion. The overall mean operative time was 162 min (range 145-210 min) and this appeared to decrease with experience. Mean hospital stay was 4 days (range 3-7 days). • Mean follow-up was 20.2 months (range 6-32 months). Satisfactory drainage with decreased hydronephrosis was documented in all patients on ultrasonography and intravenous urography.
Conclusion:
• Our study shows that retroperitoneal laparoscopic dismembered pyeloplasty is a feasible and effective alternative to open pyeloplasty with a relatively minimal complication rate in children 3 years of age and older, but it should be undertaken by experienced laparoscopic surgeons.
