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Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants
Robert M Turner1, Janelle A Fox, Jeffrey J Tomaszewski
1Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. turnerrm@upmc.edu
Insights
Laparoscopic pyeloplasty is a viable option for infants with ureteropelvic junction obstruction, demonstrating a high success rate and minimal complications. This minimally invasive approach offers comparable efficacy to open surgery in pediatric patients.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of kidney issues in children.
- While open pyeloplasty is established, the efficacy of laparoscopic pyeloplasty in infants is less defined.
Purpose of the Study:
- To evaluate the safety and efficacy of transperitoneal laparoscopic pyeloplasty in infants younger than one year.
- To present updated experience with this minimally invasive technique in a young pediatric population.
Main Methods:
- Retrospective review of 29 infants undergoing transperitoneal laparoscopic pyeloplasty for symptomatic or radiographic UPJ obstruction.
- Follow-up included regular renal ultrasound; treatment failure was defined by persistent obstruction or need for reoperation.
Main Results:
- All 29 laparoscopic pyeloplasties were completed successfully in infants aged 2-11 months.
- The overall success rate was 92%, with a 9-month median follow-up.
- Three postoperative complications (ileus, wound infection, pyelonephritis) and two cases requiring reoperation were reported.
Conclusions:
- Laparoscopic pyeloplasty in infants is technically demanding but achievable at specialized centers.
- The procedure demonstrated a high success rate (92%) with minimal morbidity, comparable to other treatment modalities.
Purpose:
Laparoscopic pyeloplasty and open pyeloplasty have comparable efficacy for ureteropelvic junction obstruction in pediatric patients. The role of laparoscopic pyeloplasty in infants is less well defined. We present our updated experience with laparoscopic pyeloplasty in children younger than 1 year.
Materials And Methods:
We retrospectively reviewed the records of all 29 infants treated with transperitoneal laparoscopic pyeloplasty for symptomatic and/or radiographic ureteropelvic junction obstruction from May 2005 to February 2012. Patients were followed with renal ultrasound at regular intervals. Treatment failure was defined as the inability to complete the intended procedure, persistent radiographic evidence of obstruction and/or the need for definitive adjunctive procedures.
Results:
Transperitoneal laparoscopic pyeloplasty was performed in 29 infants 2 to 11 months old (mean age 6.0 months) weighing 4.1 to 10.9 kg (mean ± SD 7.9 ± 1.6). Followup was available in all except 5 patients (median 13.9 months, IQR 7.7-23.8). Mean operative time was 245 ± 44 minutes. All cases were completed laparoscopically. Three postoperative complications were reported, including ileus, superficial wound infection and pyelonephritis. Two patients had persistent symptomatic and/or radiographic evidence of obstruction, and required reoperative pyeloplasty. The overall success rate was 92%.
Conclusions:
Laparoscopic pyeloplasty in infants remains a technically challenging procedure limited to select centers. Our early experience revealed a success rate comparable to that of other treatment modalities with minimal morbidity.
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