ABSTRACT
For the treatment of UPJO with success rates of up to 95%. Current reports of laparoscopic pyeloplasty showed success rates >95%. We aim at defining a new gold standard by evaluating the results of laparoscopic pyeloplasty in a high volume laparoscopy center. The research done between October 2009 and March 2011, 26 patients having primary UPJO were operated using conventional laparoscopy in the department of Urology, Klinikum Dortmund hospital, Germany. Preoperative evaluation included clinical assessment, abdominal ultrasound, MAG3 diuretic renography and retrograde pyelography. Postoperative follow-up included assessment of pain, analgesic requirements, laboratory parameters, abdominal ultrasound and reflux retrograde pyelography. Long term follow-up included improvement of symptoms; and pelvi-calyceal decompression by ultrasound, retrograde pyelography and MAG3 diuretic renography. Results were as follow the age range of the 26 patients was 13-74 years [mean 42.2, SD 17.6], 13 males and 13 females. The cause of obstruction was intrinsic stenosis in 11[42.4%], crossing lower pole vessel[s] in 14[53.8%] and external adhesions in one patient [3.8%]. All cases had a unilateral lesion; with the 26 patients equally divided as regards the side of obstruction. Pain was the presenting symptom in 20 patients [76.9%]. Operative time ranged 135-300 min. [mean 211.5, SD 41.9]. Intraoperative blood loss was generally negligible and no intraoperative complication occurred. There was no conversion to open surgery in any case. The total hospital stay ranged 5-11 days [mean 7.8, SD 1.5]. Follow-up ranged 3-18 months. In 24 patients, there was a definite resolution of pain and other symptoms postoperatively. Postoperative evaluation showed a statistically significant improvement of the degree of hydronephrosis by both ultrasonography and retrograde pyelography [p = 0.0001]. In 2 patients with mild postoperative radiological improvement, despite the clinical resolution of symptoms, MAG3 scan showed a mild obstructive drainage pattern. Criteria of success, defined as relieve of symptoms and obstruction together with a half-time clearance of 10 min. or less, shown a short-term success rate of 96%. In conclusion laparoscopic pyeloplasty is a safe and effective treatment option; and it could be a reasonable replacement for open surgery as a new gold standard for treatment of UPJO