Laparoscopic dismembered pyeloureteroplasty: a single institution's 3-year experience.

PURPOSE: To review our most recent experience with laparoscopic dismembered pyeloureteroplasty (LDP) as treatment for ureteropelvic junction (UPJ) obstruction.

PATIENTS AND METHODS: All patient charts from March 1, 2000, through March 1, 2003, were reviewed to identify individuals who had undergone LDP. Twenty-two consecutive procedures were performed on 21 patients. The average patient age was 37 years (range 6-77 years). Multiple data points were collected, including patient age, presenting symptoms, degree of hydronephrosis, presence of crossing vessels, operative time (cystoscopy, retrograde pyelography, stent placement, and LDP), estimated blood loss (EBL), length of hospital stay (time to discharge home after preoperative admission), parenteral analgesic use, complications, and results of follow-up imaging studies and symptoms (including an analog pain scale). Mean and range values for quantitative data are reported.

RESULTS: Twelve right and ten left renal units were operated on; in 12 UPJs, a crossing vessel was causative of the obstruction. The mean operative time was 291 minutes (range 180-500 minutes) and the mean intraoperative EBL was 63 mL (range 20-100 mL). There were no conversions to open surgery. The mean hospital stay was 40 hours (range 24-120 hours). The average number of parenteral analgesic doses before conversion to oral narcotics was 5 (range 1-10). Three patients had successful pyelolithotomies at the time of reconstruction with a 100% stone-free rate on postoperative imaging studies. The average time of follow-up evaluation was 199 days (range 31-705 days). All patients either had serial ultrasound examinations, diuretic intravenous urograms, or both for follow-up evaluation, which demonstrated improvement in hydronephrosis and renal drainage. All patients with pain preoperatively had resolution of their symptoms postoperatively. There were no intraoperative complications, seven early postoperative complications (three urinary tract infections, two hospital readmissions for ileus, one urine leak, and one delayed hemorrhage, presumably from a trocar site).

CONCLUSIONS: Laparoscopic dismembered pyeloureteroplasty is safe and effective and associated with minimal morbidity.