Introduction: Ureteropelvic junction obstruction (UPJO) can lead to symptoms such as hydronephrosis and progressive renal damage. We explain our primary experiences about laparoscopic pyeloplasty (LP) as the new probable gold standard in the treatment of UPJO in comparison with open pyeloplasty (OP).
Methods: Between March 2008 and August 2009, after confirming the diagnosis of UPJO, 21 patients underwent transperitoneal dismembered LP and 25 patients underwent dismembered OP. This selection was not randomized and was related to the surgeon’s experience. Success was assessed by IVU and diuretic renograghy 3 months after surgery. Important parameters were compared between 2 groups. P < 0.05 was considered statistically significant.
Results: No significant differences were seen in the mean age and gender between the 2 groups. LP (280 ± 95 minutes) had a significantly (p = 0.003) higher mean operating room time than OP (204 ± 59 minutes). The mean indwelling duration of drainage (LP: 2.5 ± 1.56 days; OP: 2.1 ± 1.14 days; p = 0.31) and the mean postoperative hospital stay (LP: 4.6 ± 1.76 days; OP: 4.3 ± 1.55 days; p = 0.934) were similar between the 2 groups. The mean dosage of postoperative analgesics and complication rates in LP (26.25 mg; 23.8%) were lower than OP (38.33 mg; 36%). But these differences were not significant. The mean duration of return to normal activity after discharge in LP was significantly lower than OP (3.9 versus 5.2 days; p = 0.002).
Conclusion: Despite a shorter operating room time of OP, LP is a gold substitute for OP even in primary experiences due to cosmetic advantages, faster returns to normal activity, and comparable results. Laparoscopic pyeloplasty can be the gold standard treatment for UPJO if LP is performed by experienced and skillful surgeons.
Siavash Falahatkar, Ali Roushani, Hamidreza Nasseh, Ehsan Kazemnezhad, Keivan Gholamjani Moghaddam, Seyedeh Mahboobe Raoofi, Mani Mohiti Asl, Ahmad Enshaei, Alireza Farzan
Submitted April 19, 2012 - Accepted for Publication June 1, 2012
KEYWORDS: Laparoscopic pyeloplasty, open pyeloplasty, ureteropelvic junction obstruction
CITATION: UroToday Int J. 2012 August;5(4):art 33. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.06