Transperitoneal and retroperitoneal laparoscopic nephrectomy for giant hydronephrosis

Purpose: We evaluate laparoscopic nephrectomy for giant hydronephrosis with an emphasis on the operative technique of retroperitoneoscopic surgery. Materials and Methods: During the last 2 years 13 men and 5 women underwent laparoscopic nephrectomy for giant hydronephrosis via a transperitoneal (6 ) or retroperitoneal (12) approach. The etiology was congenital ureteropelv ic junction obstruction in 17 patients and hydronephrosis caused by stone d isease in 1. Three patients had a contralateral obstructed kidney. Renal pa rameters were normal in all patients. Results: All procedures were successfully completed without the need for co nversion to open surgery. Mean operating time was 113.8 minutes (range 70 t o 165) and average blood loss was 260 ml. (range 40 to 600). No patient req uired a blood transfusion. Postoperative recovery was uneventful with an av erage postoperative hospital stay of only 3.2 days (range 2 to 5). Conclusions: Laparoscopic nephrectomy is a good alternative to open surgery for giant hydronephrosis and significantly reduced the morbidity of surger y. A retroperitoneal approach is feasible, despite the large amount of retr operitoneal space occupied by these hugely dilated kidneys. Modifications o f our technique have been invaluable to the successful outcome in this seri es.