Retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction.

OBJECTIVE: To compare classical open pyeloplasty with retroperitoneal laparoscopic pyeloplasty in effectiveness, potential advantages and complications.

MATERIALS AND METHODS: Between March 2006 and April 2010, 113 patients with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty were retrospectively compared with those of 59 patients who underwent open dismemberse pyeloplasty through a retroperitoneal flank approach. The Chi-square test was used for statistical analysis of qualitative data and the Student t-test for analysis of quantitative data. P < 0.05 was considered significant.

RESULTS: Operative time was shorter in the retroperitoneal laparoscopic group (mean 125 min) compared to the open pyeloplasty group (mean 142 min, P < 0.05). Mean hospital stay was shorter in the retroperitoneal laparoscopic group (mean 6 days, compared to 9 days, open). Complication rates, including anastomotic urinary leakage, stenosis and infection, were 4.42% in retroperitoneoscopic compared to 6.78% open surgery. Anastomotic leakage was 3 cases in the retroperitoneoscopic group versus 1 case in the open group. Success, defined as improved ultrasonic or renographic parameters, with resolution of symptoms where discernable, was noted in 98.0% of the open group and 98.1% of the retroperitoneoscopic group with a mean follow up of 38.4 and 32.7 months, respectively.

CONCLUSIONS: Retroperitoneal laparoscopic dismembered pyeloplasty in treatment of ureteropelvic junction obstruction is a minimally invasive, safe and effective therapy with short procedure time, less complications, and shorter convalescence.