Long-term outcome of laparoscopic pyeloplasty: multicentric comparative study of techniques and accesses

The aim of the present study was to analyze long-term follow up (18-108 months) of different techniques and routes for laparoscopic repair of uretero-pelvic junction obstruction comparing efficacy and results.

A retrospective analyses of 133 laparoscopic pyeloplasties in 132 patients (mean age 35 years) between August 1995 and November 2008 was performed. Transperitoneal route was performed in 114 patients, and retroperitoneal route was performed in 19 patients. Different repair techniques (dismembered and non-dismembered) were applied at the surgeon's discretion.

Average operative time was 127 minutes (range 45-370). Average blood loss was 127 mL, and mean hospital stay was 24 hours. Complications occurred in 9.6% of surgeries, and conversion rate was 1.7%. Urinary leak occurred after eight (6.1%) surgeries, all managed conservatively. Overall success rate of laparoscopic repair was 96%, higher for dismembered versus non-dismembered procedures (97% versus 89%, P = .04).

Laparoscopic pyeloplasty is a reproducible, highly effective, and minimally invasive treatment for uretero-pelvic junction obstruction. Surgical technique affects operative time and long-term success rates. Dismembered techniques seem to remain more effective after a long-term follow up. Surgical route does not seem to affect success rates.