Efficacy and late complications of laparoscopic pyeloplasty: experience involving 125 consecutive ureters

Abstract

Introduction: Laparoscopic pyeloplasty is now widely recognized as a minimally invasive alternative for the surgical management of ureteropelvic junction obstruction. However, there have been insufficient reports describing the long-term outcomes and the stability of the results. In addition, late complications have not been thoroughly discussed.

Methods: Between October 1999 and December 2010, we performed laparoscopic pyeloplasty on 125 consecutive ureters in 119 patients with an obstruction of the ureteropelvic junction. We performed dismembered Anderson-Hynes pyeloplasty, Fenger plasty and Y-V flap in 108 (86.4%), 15 (12.0%), and 2 ureters (1.6%), respectively.

Results: All procedures were completed successfully. Median operative time was 200 min (range, 80-775 min) and median estimated blood loss was 20 mL (range, 20-250 mL). Intraoperative and postoperative complications categorized as Clavien grade II and III occurred in 11 (8.9%) procedures. Among them, three were observed after 12 months postoperative and all involved renal stones in the collapsed pelvis. In 120 (96%) ureters, hydronephrosis improved and/or obstructive pattern on diuretic renography disappeared during a median follow-up period of 45 months (range, 5-146 months). The degree of hydronephrosis steadily improved for more than 2 years, and re-obstruction was never observed after 1 year postoperative.

Conclusion: The efficacy of laparoscopic pyeloplasty seems to be durable over 2 years postoperatively. Because obstruction recurrence was not observed after 12 months postoperative, patients with complete disappearance of hydronephrosis may unnecessarily be followed longer than 2 years. However, cases with persisting hydronephrosis should be regularly monitored because of the remaining possibility of stone formation.