OUTCOME BASED COMPARISON OF SURGICAL APPROACHES FOR PEDIATRIC PYELOPLASTY - DORSAL LUMBAR VERSUS FLANK INCISION

Purpose: Dismembered pyeloplasty for the correction of ureteropelvic j unction obstruction can be performed through a flank or dorsal lumbar incision. We compared the records of children who had undergone pyelop lasty by each approach to determine if 1 technique was more advantageo us. Materials and Methods: We retrospectively reviewed the records of 33 consecutive children undergoing simple dismembered pyeloplasty by a single pediatric urologist from 1992 to 1996. The flank approach was used exclusively in the first group of patients who underwent repair i n 1992 to 1993 and the dorsal lumbar incision was used exclusively in the second group after 1993. Data were obtained from hospital and clin ic records, and both groups were compared with the 2-tailed t test. Re sults: Pyeloplasty was done by dorsal lumbar incision in 16 cases and via the flank approach in 17. One patient in each group had undergone simultaneous bilateral pyeloplasties. Although overall comparison of b oth groups revealed no differences in operative time, in children olde r than 1 year pyeloplasty through a dorsal lumbar incision (108.5 minu tes) was statistically significantly faster than the flank approach (1 44.4 minutes). Hospital stay was approximately 2 days shorter in infan ts who had a dorsal lumbar (25.7 hours) versus a flank incision (73 ho urs), and this difference did reach statistical significance if the bi lateral pyeloplasty patients were excluded. Hospital costs were less f or the dorsal lumbar group but the difference was not statistically si gnificant. Success and complication rates were similar between groups with 2 patients in each group requiring additional procedures. Review of other series of repair of ureteropelvic junction obstruction demons trated that the dorsal lumbar repair had equivalent or shorter operati ve times and lengths of hospitalization compared to newer endoscopic m ethods, and the outcomes were superior. Conclusions: The dorsal lumbar incision is a safe and efficacious approach to pyeloplasty and may be more cost-effective. In our series it was significantly faster in pat ients older than 1 year and resulted in shorter hospital stays in thos e younger than 1 year old.