Laparoscopic pyeloplasty, initial experience in the management of UPJO

Aim: Laparoscopic pyeloplasty (LP) has emerged in the last 8 years as an al ternative to open surgery. We here present the results of our series of pat ients and evaluate LP in the management of ureteropelvic junction obstructi on (UPJO). Patients and Methods: Patients with UPJO confirmed by renogram and/or sympt oms were offered surgical correction by LP. The risks, alternatives, and no velty of the technique at our centre were explained to obtain informed cons ent. Patients were assessed pre- and postoperatively and data including ope rative time, analgesic requirements, time to self care and full activity we re recorded. Fifteen patients with a mean age of 38.4 years were recruited in whom 13 successful Anderson Hayes transperitoneal LI's were performed in 12 patients. Results: Mean operative time was 261 min and blood loss was minimal. Analge sic requirements were also minimal with patients requiring PCA for an avera ge of 1.1 days. Average days to free fluids were 1.5 days and the mean hosp ital stay was 4.4 days. Average number of days to self care and full activi ty were 3.2 and 12.2 days, respectively. Patients in employment returned to work after an average of 4.4 weeks, In 9/10 cases with preoperative loin p ain, patients had symptom relief following surgery. Postoperative renogram at 6 months confirmed improved drainage in 12 LP procedures. At a mean foll ow up of 20 months, 11/12 patients remain symptomatically well. Conclusions: In this series, LP operative times and outcome closely match t hose of larger series and the functional results are comparable to open pye loplasty. We conclude that LP is a suitable first line option for UPJO surg ery provided standard laparoscopic equipment and a trained urologist are av ailable.