Transperitoneal laparoscopic pyeloplasty in children: does upper urinary tract anomalies affect surgical outcomes?
João Arthur Brunhara1, Paulo Renato Marcelo Moscardi1, Marcos Figueiredo Mello1
1Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil.
Insights
Transperitoneal laparoscopic pyeloplasty is a feasible and effective treatment for ureteropelvic junction obstruction (UPJO) in children, even with complex anatomical variations. Outcomes and success rates are comparable between typical and complex cases, demonstrating its broad applicability.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Renal Anatomy
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
- Laparoscopic pyeloplasty has become a standard surgical approach for UPJO.
- The feasibility in complex UPJO cases with associated anomalies requires further assessment.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transperitoneal laparoscopic pyeloplasty in pediatric UPJO.
- To compare outcomes in children with complex UPJO (associated anomalies) versus isolated UPJO.
Main Methods:
- Retrospective review of 82 children undergoing transperitoneal laparoscopic pyeloplasty over 12 years.
- Categorization into two groups: normal anatomy (Group 1) and complex anatomy (Group 2, n=11).
- Analysis of demographics, operative time, complications, success rates, and hospital stay.
Main Results:
- No significant differences in mean age, operative time, or major complication rates between groups.
- High success rates for radiologic and flank pain improvement in both groups (90.9-93.4%).
- Comparable median hospital stays (4 days for Group 1, 4.8 days for Group 2).
Conclusions:
- Transperitoneal laparoscopic pyeloplasty is a feasible and effective surgical option for pediatric UPJO.
- The procedure demonstrates comparable outcomes in children with complex renal or urinary tract anomalies.
- This technique offers a safe and successful management for a wide spectrum of UPJO cases.
Objective:
To assess the feasibility and outcomes of laparoscopic pyeloplasty in children with complex ureteropelvic junction obstruction (UPJO) and compare to children with iso-lated UPJO without associated urinary tract abnormalities.
Material And Methods:
Medical records of 82 consecutive children submitted to transperitoneal laparoscopic pyeloplasty in a 12-year period were reviewed. Eleven cases were con-sidered complex, consisting of atypical anatomy including horseshoe kidneys in 6 patients, pelvic kidneys in 3 patients, and a duplex collecting system in 2 patients. Patients were di-vided into 2 groups: normal anatomy (group 1) and complex cases (group 2). Demographics, perioperative data, outcomes and complications were recorded and analyzed.
Results:
Mean age was 8.9 years (0.5-17.9) for group 1 and 5.9 years (0.5-17.2) for group 2, p=0.08. The median operative time was 200 minutes (180-230) for group 1 and 203 minutes (120-300) for group 2, p=0.15. Major complications (Clavien ≥3) were 4 (5.6%) in group 1 and 1 (6.3%) in group 2, p=0.52. No deaths or early postoperative complications such as: urinoma or urinary leakage or bleeding, occurred. The success rate for radiologic improvement and flank pain improvement was comparable between the two groups. Re-garding hydronephrosis, significant improvement was present in 62 patients (93.4%) of group 1 and 10 cases (90.9%) of group 2, p=0.99. The median hospital stay was 4 days (IQR 3-4) for group 1 and 4.8 days (IQR 3-6) for group 2, p=0.27.
Conclusions:
Transperitoneal laparoscopic pyeloplasty is feasible and effective for the management of UPJO associated with renal or urinary tract anomalies.
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