Retroperitoneoscopic pyeloplasty for primary hydronephrosis: preliminary results of the first 30 operations.

Objective: To evaluate the preliminary results of retroperitoneoscopic pyel oplasty (RP)for the treatment of primary uretero pelvic junction, syndrome (PUPJS) in terms of operating time, operative and postoperative complicatio ns, clinical functional and radiographic results, length of hospital stay a nd resumption of physical activity. Material and Methods: From November 1997 to June 2000, from a consecutive s eries of 59 patients treated for an anomaly of the ureteropelvic junction ( UPJ), the 29 patients (18 females and Il males, mean age: 35.6 years [range : 17-68]) operated by RP for PUPJS (bilateral in one case) were reviewed. T welve patients presented a lower pole vascular pedicle and 24 patients had an extrasinusal renal pelvis. The RP technique was identical for all patien ts (4 ports) and the UPJ repair was performed according to the technique de scribed by Anderson-Hynes and Miss (28 cases) or Y-V plasty (2 cases). Results: The mean operating time was 150 minutes (range: 120-240) and the m ean hospital stay was 4.2 days (range: 3-10). There were no intraoperative complications, but one conversion (3.3%) was necessary because of major adh esions. postoperative complications (23.3%) consisted of. four urinary trac t infections with one case of acute pyelonephritis, perirenal haematoma, ur ine leak in the Redon drain due to obstructed double J stent, migration of the double J stent underneath the anastomosis leading to unstentable cicatr icial stricture (treated by open pyeloplasty 3 weeks later). With a mean fo llow-up of 19.7 months (range: 7-40), 28 patients were asymptomatic and one patient presented persistent lumbar pain at 9 months with no signs of recu rrence. The 3-month IVU, performed in 27 patients, showed reduction of hydr onephrosis in 85.7% of cases and a patent ureteropelvic junction in 96.3% o f cases. Complete resumption of physical activity and return to work were p ossible an average of 1 month postoperatively (a fortnight for the populati on tinder the age of 40 years). Conclusion: PUPJS can be treated by RP according to the same principles as conventional surgery. RP pyeloplasty can be performed with an acceptable op erating time and morbidity. The functional and radiological results in term s of patency of the UPJ need to be assessed in the longer term.