Laparoscopic versus open pyeloplasty: Assessment of objective and subjective outcome

Purpose: We determine the subjective and objective durability of laparoscop ic versus open pyeloplasty. Materials and Methods: From August 1993 to April 1997, 42 patients underwen t laparoscopic pyeloplasty (laparoscopy group) with a minimum clinical foll owup of 12 months (mean 22). Subjective outcomes and objective findings wer e compared to those of 35 patients who underwent open pyeloplasty (open sur gery group) from August 1986 to April 1997 with a minimum clinical followup of 12 months (mean 58). We assessed clinical outcome based on responses to a subjective analog pain and activity scale. In addition, radiographic out come was assessed based on the results of the most recent radiographic stud y. Results: Of the 42 laparoscopy group patients 90% (38) were pain-free (26, 62%) or had significant improvement in flank pain (12, 29%) after surgery. Two patients had only minor improvement and 2 had no improvement in pain. S urgery failed in only 1 patient with complete obstruction. A patent uretero pelvic junction was demonstrated in 98% (41 of 42 patients) of the laparosc opy group on the most recent radiographic study (mean radiographic followup 15 months). Of the 35 open surgery group patients 91% were pain-free (21, 60%) or significantly improved (11, 31%) after surgery. One patient had onl y minor improvement and 2 were worse. Conclusions: Pain relief, improved activity level and relief of obstruction outcomes are equivalent for laparoscopic and open pyeloplasty.