[Experience with laparoscopic pyeloplasty for treating ureteropelvic junction obstruction in children. Technique and results]

Abstract

Introduction: Open pyeloplasty has been the gold standard for treating ureteropelvic junction obstruction, with a success rate greater than 90%. However, during the last decade the management has been revolutionized with the introduction of laparoscopy and endourology, yielding comparable results and fewer morbid outcomes.

Materials and methods: Between 1997 and 2007, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 31 children with a medium age of 123 months (range 36-192 months). Fourteen children underwent dismembered pyeloplasty (Anderson-Hynes) and 16 children underwent non-dismembered pyeloplasty (YV plasty) and in one child we performed an ureterolysis.

Results: The mean operating time was 120 min (range 67-257 min). In 21 cases, intraoperative findings revealed a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 93%. The two failures (laparoscopic YV plasty and laparoscopic ureterolysis) occurred in the early phase of laparoscopy and have been treated by open Anderson-Hynes plasty.

Conclusion: With increasing improvement of the suture techniques, laparoscopic pyeloplasty represents, in experienced hands, an alternative method with success rates comparable to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants.