Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction: preliminary experience

To identify whether laparoscopic pyeloplasty is a reasonable treatment option for secondary ureteropelvic junction (UPJ) obstruction.

Since March 1994, we have performed laparoscopic pyeloplasties for secondary UPJ obstruction on 4 symptomatic patients ranging in age from 26 to 39 years. Prior failed procedures included antegrade endopyelotomies (3) and acucise endopyelotomies (3). Two patients underwent two prior endopyelotomies. Techniques of laparoscopic reconstruction included Anderson-Hines dismembered (3) and Culp-Deweerd flap (1) procedures. Repairs were performed with interrupted and running 3.0 and 4.0 Vicryl sutures using intra-corporeal knots and Lapra-Ty absorbable suture clips.

Average operating time was 530 minutes (range, 465 to 645), which included preoperative cystoscopic placement of an external 7 F occlusion balloon catheter into the renal pelvis and placement of an internal double pigtail ureteral stent at the conclusion of the procedure. Average blood loss was 111 cc (range, 75 to 150). All 4 patients were found to have anterior crossing vessels intraoperatively. Average postoperative hospital stay was 4 days (range, 3 to 7). All 4 patients have a patent, nonobstructed UPJ by either Whitaker test or diuretic renography at an average of 3.3 months postoperatively (range, 1 to 5). Average return to normal activity was 4.5 weeks (range, 3 to 8). Utilizing an analogue pain scale, 2 of the patients are pain-free, and the other 2 are improved (45% and 85%) at an average of 8 months (range, 2 to 12) postoperatively. One patient developed stones in the renal pelvis and required percutaneous nephrolithotomy 10 weeks postoperatively.

Laparoscopic pyeloplasty appears to be feasible and effective, although a technically challenging operative procedure for treating secondary (postendopyelotomy) UPJ obstruction. Further clinical experience and long-term follow-up are needed.