Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children

Objective To report our initial experience of endoscopic dismembered pyelop lasty through a retroperitoneal approach in infants and children with pelvi -ureteric junction (PUJ) obstruction, Patients and methods Thirteen infants and children with PUJ obstruction und erwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25-10). Nine patients presented with complications secon dary to PUJ obstruction, including urinary tract infection, pyonephrosis an d increasing hydronephrosis with impairment in renal function. The other fo ur patients had recurrent loin pain secondary to intermittent PUJ obstructi on, The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction), The retroperitoneal space was e ntered via a l-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5- mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-uret eric anastomosis fashioned using fine polydioxanone sutures over a double-p igtail ureteric stent, Results The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (10 3-235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan. Conclusions Retroperitoneoscopic dismembered pyeloplasty is effective and s afe in infants and young children giving a good early outcome, although the long-term results await further studies.