Laparoscopic Pyeloplasty: The First One Hundred Cases

Introduction
Laparoscopic pyeloplasty was developed as a minimally invasive alternative to an open procedure in the treatment of uretero-pelvic junction obstruction (UPJO). Long term follow-up has not yet been reported. We present the experience with the first one hundred consecutive cases performed at our institution.

Materials and Methods
A retrospective review of 100 consecutive laparoscopic pyeloplasties in 99 patients (means age 37.3 years) between Augusts 1993 and January 1999 was performed. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function. Repair was for a primary UPJ in 83 patients and secondary in 17. Four types of repairs, Anderson Hynes Dismembered (71), Y-V plasty (20), Heineke Michuliz (8) and Davis intubated ureterotomy (1), were used. Type of repair used was dictated by intra-operative findings. Twenty patients had non-obstructing renal stones and underwent concomitant pyelolithotomy. All patients were assessed for symptoms and obtained radiographic evaluation for anatomical obstruction.

Results
The average operating room time was 4.2 hours, but decreased with surgeon experience. Average blood loss was 181 cc and hospital stay 3.3 days. Two patients required blood transfusion. A crossing vessel was found in 57 patients. With a mean clinical and radiographic follow-up of 2.7 and 2.2 years, 96% of the patients were free of obstruction on follow-up radiographic imaging. Of the patients who underwent concomitant pyelolithotomy, 18 (90%) were stone free at last follow-up. All failures occurred within the first year. There were 12 complications in this series.

Conclusions
In experienced hands, laparoscopic pyeloplasty is an effective alternative treatment for symptomatic UPJO. The results appear durable and comparable to open pyeloplasty with decreased post-operative morbidity.