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. 2024 Feb;56(2):381-388.
doi: 10.1007/s11255-023-03799-4. Epub 2023 Sep 26.

Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics

Mohammad Daboos  1 , Rachida Lamiri  2 , Bochra Aziza  2 , Mohamed Marzougui  2 , Nahla Kechiche  2 , Lassaad Sahnoun  2 , Mohamed Abdelaziz  3 , Mohamed Abdelmaboud  3 , Ahmed Azab  3 , Mahmoud Shaban  3
Affiliations

Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics

Mohammad Daboos et al. Int Urol Nephrol. 2024 Feb.

Abstract

Background: The management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach.

Materials and methods: A retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty.

Results: There were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant.

Conclusion: Laparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach.

Keywords: Laparoscopic assisted pyeloplasty; Open pyeloplasty; Pediatric UPJO; Poorly functioning kidney.

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Conflict of interest statement

The authors declare no conflicts of interest or financial disclosures.

Figures

Fig. 1
Fig. 1
A Mobilization of the renal pelvis and ureter. B Exteriorization of the renal pelvis and UPJ. C New UPJ was dropped back into the peritoneal cavity
Fig. 2
Fig. 2
A Exposure of UPJ and dissection of the renal pelvis. B The anastomosis was completed with inserting a ureteric stent
See this image and copyright information in PMC

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