Laparoscopic versus open pyeloplasty: a multi-institutional prospective study.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Uteropelvic junction obstruction (UPJO) is a common cause of pediatric and adult kidney obstruction.
• Pyeloplasty is the gold standard surgical treatment for UPJO.
• Laparoscopic pyeloplasty (LP) has emerged as an alternative to open pyeloplasty (OP).

Purpose of the Study:

• To prospectively compare perioperative and functional outcomes of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP).
• To evaluate patient satisfaction and recovery between the two surgical approaches for UPJO.

Main Methods:

• A prospective study involving 102 patients with primary UPJO undergoing either LP (51) or OP (51) across three academic institutions.
• Data collected included operative time, blood loss, complications, hospital stay, and SF-8 Health Survey scores.
• Postoperative follow-up included imaging (ultrasound, IVU) and MAG-3 renal scans.

Main Results:

• LP demonstrated significantly shorter hospital stays (2.7 vs. 9.09 days) and reduced postoperative analgesia requirements (101.1 vs. 459.1 mg).
• OP had a significantly shorter operative time (153.2 vs. 219.8 min).
• Success rates were comparable: 96.1% for OP and 94.1% for LP, with a median follow-up of 19.7 months.

Conclusions:

• Laparoscopic pyeloplasty (LP) provides faster recovery and higher patient satisfaction for UPJO.
• Open pyeloplasty (OP) remains advantageous with shorter operative times and a potentially lower retreatment rate.
• Both LP and OP are effective treatments for UPJO, with distinct advantages in recovery and operative efficiency.