Laparoscopic pyeloplasty for pediatric UPJO: Clinical outcomes from five Arabian Gulf tertiary centers over ten years
Adel Aljneibi1, Hesham Soliman Safoury2, Mohamed Hobeldin1
1Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Insights
Laparoscopic pyeloplasty is a safe and effective treatment for ureteropelvic junction obstruction (UPJO) in infants and children. This minimally invasive approach demonstrates excellent outcomes, even in complex cases and redo surgeries.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction obstruction (UPJO) is often detected prenatally, with surgical intervention necessary for persistent cases to preserve renal function.
- Laparoscopic pyeloplasty is increasingly favored over open surgery, even in pediatric patients, though optimal timing and techniques are debated.
Purpose of the Study:
- To evaluate the 10-year multicenter experience with laparoscopic pyeloplasty in children across five tertiary centers in the Arabian Gulf.
- To assess the safety and efficacy of laparoscopic pyeloplasty in a broad pediatric patient population, including infants and those with complex anatomy or prior failed surgeries.
Main Methods:
- A retrospective review of 422 patients (459 renal units) who underwent laparoscopic pyeloplasty between January 2014 and January 2024.
- Data collected included demographics, clinical presentation, surgical indications, intraoperative findings, and outcomes, with statistical analysis performed.
Main Results:
- Mean age at surgery was 38 months, with a significant proportion (36% <6 months, 55% <12 months) treated early in life.
- Transperitoneal pyeloplasty was the predominant approach (443 units). Aberrant vessels and other anomalies were identified.
- Mean operative time decreased over the study period (p < 0.001). Redo pyeloplasty was required in 2.6% of cases. Ultrasound showed higher sensitivity and specificity than MAG3 in predicting failure.
Conclusions:
- Laparoscopic pyeloplasty is safe and effective in infants and children, including redo and anatomically complex cases.
- Both transperitoneal and retroperitoneoscopic approaches yield excellent outcomes.
- Ultrasound is a reliable follow-up tool, potentially reducing reliance on radionuclide imaging.
Introduction:
Ureteropelvic junction obstruction (UPJO) is frequently identified in infancy due to routine prenatal screening. While many cases resolve, true obstructions require surgery to preserve renal function. Laparoscopic pyeloplasty has increasingly replaced open surgery, even in infants, though optimal timing and approach remain debated.
Objective:
We report a 10-year multicenter experience with laparoscopic pyeloplasty in children across five tertiary centers in three Arabian Gulf countries.
Study Design:
A retrospective review of 422 patients (459 renal units) who underwent laparoscopic pyeloplasty from January 2014 to January 2024 was conducted. Demographic data, clinical presentation, investigative findings, surgical indications, intraoperative findings, and outcomes were retrieved from electronic records. Data were tabulated and examined for statistical significance.
Results:
Mean age at surgery was 38 ± 46 months; 152 were <6 months and 230 < 12 months. Transperitoneal pyeloplasty was used in 443 renal units, retroperitoneoscopic in 16. Aberrant vessels (5.9 %), retrocaval ureters (0.4 %), and other anomalies (2.8 %) were identified. Seven patients had prior failed pyeloplasty (mostly open). Conversion to open surgery occurred in 2 cases (<1 %); no intraoperative complications were reported. Mean operative time was 209 ± 67 min, decreasing significantly over time (p < 0.001). Nine patients (2.6 %) required redo pyeloplasty. Ultrasound outperformed MAG3 in predicting failure (sensitivity/specificity: 94 %/100 % vs 91 %/90 %).
Discussion:
Laparoscopic pyeloplasty has become increasingly accepted, including for infants, as surgical expertise and familiarity with minimally invasive techniques have improved. Our multicenter series of 459 renal units represents one of the largest reported and affirms the safety and efficacy of laparoscopic pyeloplasty across a broad patient population. A substantial proportion of our patients were treated early in life, with 36 % under 6 months and 55 % under 12 months. Although younger age was historically considered a limitation, our findings support previous reports that younger infants can be safely and effectively managed laparoscopically in experienced hands. This study is limited by its retrospective nature and lack of a comparator group undergoing open pyeloplasty. However, as the field moves forward, future studies will likely focus on comparative outcomes between laparoscopic and robotic pyeloplasty rather than the open approach.
Conclusion:
Laparoscopic pyeloplasty is safe and effective in infants and children, including redo and anatomically complex cases. Both transperitoneal and retroperitoneoscopic approaches yield excellent outcomes. Ultrasound is a reliable follow-up tool, potentially reducing reliance on radionuclide imaging.
