LAPAROSCOPIC PYELOPLASTY - EXPERIENCE WITH THE INITIAL 30 CASES

Purpose: We assessed the intermediate effectiveness of laparoscopic py eloplasty in the treatment of the obstructed ureteropelvic junction. M aterials and Methods: A total of 30 pyeloplasties was performed for sy mptomatic ureteropelvic junction obstruction (24 primary and 6 seconda ry cases). Two separate types of reconstruction were performed, that i s dismembered (26 patients) and Y-V (4) pyeloplasty. All patients were followed with excretory urography or diuretic renography. Moreover, f actors affecting the learning curve (surgical technique, prior laparos copic experience and cause of obstruction) were evaluated. Results: A lower pole segmental renal vessel was found at the ureteropelvic junct ion in 18 patients (60%). Operative time ranged from 2.25 to 8.0 hours (mean 4.5). Postoperative morbidity (mean narcotic requirement 37.3 m g. morphine sulfate, mean hospital stay 3.5 days and convalescence 3 w eeks) was minimum. At radiographic followup (mean 16.3 months, range 4 to 73) 97% of the patients demonstrated a patent ureteropelvic juncti on and resolution of or substantial decrease in hydronephrosis. Conclu sions: In the hands of an experienced laparoscopist, outcomes indicate that laparoscopic pyeloplasty shows success similar to that of open p yeloplasty but longer term outcomes must be assessed.