Extraperitoneal laparoscopic pyeloplasty: A multicenter study of 55 procedures

Purpose: We assessed the feasibility, reproducibility and morbidity of retr operitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction . Materials and Methods: A total of 55 retroperitoneal laparoscopic pyeloplas ties were performed at 3 institutions between September 1996 and May 2000 i n 33 women and 21 men. Results were analyzed in regard to radiological asse ssment by excretory urography at 3 months, complications and hospital stay. Results: We performed dismembered pyeloplasty in 48 cases and Fenger plasty in 7 cases. Crossing vessels were noted in 23 patients. The conversion rat e was 5.4%. Mean operative time was 185 minutes (range 100 to 260), mean ho spital stay was 4.5 days (range 1 to 14) and mean followup was 14.4 months (range 6 to 43.6). The overall complication rate was 12.7%. Complications i n 7 patients included hematoma in 3, urinoma in 1, severe pyelonephritis in I and anastomotic stricture in 2 requiring open pyeloplasty at 3 weeks and delayed balloon incision at 13 months, respectively. Excretory urography i n 50 patients and ultrasound in 4 showed. decreased hydronephrosis in 88.9% at 3 months. Normal physical activity and absent pain were reported by 47 patients (87%) 1 month after surgery. Conclusions: Retroperitoneal laparoscopic pyeloplasty seems to be a valuabl e alternative to open pyeloplasty for ureteropelvic junction obstruction. T he long-term outcome must be assessed before this procedure may be definiti vely validated.