The long-term results of laparoscopic retroperitoneal pyeloplasty in adults

OBJECTIVES To report the long-term outcome of laparoscopic retroperitoneal pyeloplasty (LRP) in adults. PATIENTS AND METHODS Thirty patients underwent LRP for primary pelvi-ureteric junction obstruction (PUJO). Anderson-Hynes dismembered pyeloplasty was used in 28 patients and a Foley Y-V pyeloplasty in two. A JJ stent was inserted antegradely during the procedure. Patients were reviewed at 1 month after LRP for stent removal, and then at 6 and 12 months routinely, using excretory urography. RESULTS The mean patient age was 29.7 years, with a female predominance of 60%. Conversion to open surgery was mandated by dense adhesions secondary to previous pyelonephritis in three patients, and difficulty in suturing in one. The mean (range) operative duration was 228 (190-280) min. There was a crossing vessel in 11 patients and it was not transposed in any. The mean hospital stay after LRP was 4.2 days. The mean (range) follow-up was 60 (29-106) months. Of the 26 patients who had complete laparoscopic procedures, 23 had no evidence of obstruction on long-term postoperative intravenous urography and/or diuretic renography. CONCLUSION LRP combines the high functional success rate of open pyeloplasty in the long term and the minimally invasive morbidity of laparoscopy.