Pediatric Laparoscopic Pyeloplasty: 4-Year Experience

Main Category: Urology / Nephrology
Also Included In: Clinical Trials / Drug Trials
Article Date: 16 Mar 2008 - 0:00 PDT

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UroToday.com - A study from the University of Oklahoma by Lam, et. al. evaluated their four-year experience with pediatric laparoscopic pyeloplasty. They retrospectively reviewed the records of 59 patients who underwent surgical correction for UPJ obstruction in a single system. Of these patients 27 underwent open dismembered pyeloplasty and 28 underwent laparoscopic dismembered pyeloplasty, while 4 others underwent percutaneous endopyelotomy for concomitant urolithiasis. Of the 28 laparoscopic pyeloplasties, one patient had bilateral laparoscopic repairs at different times, giving the study a total of 29 renal units that were reconstructed laparoscopically. They had one conversion and one laparoscopic to open conversion in the group. The boy to girl ratio was 18 to 11, respectively. The overall mean age was 8.1 years with a range of 1.6 to 18.9.

At a mean follow-up of 27.9 months (range 7.6 to 58), all the patients demonstrated improvement of symptoms and drainage on nuclear renography or at least a decrease in the rate of hydronephrosis on renal bladder ultrasound. The group noted that their first laparoscopic pyeloplasty resulted in open conversion. This was the result of failure to progress with the renal pelvic anastomosis. Another patient developed a retroperitoneal urinoma despite having a ureteral stent placed for the operation. It subsequently resolved with urethral catheter drainage without any sequelae. A third patient in the laparoscopic group required hospitalization longer than 23 hours because of a postoperative ileus which resolved without any issues.

This series from Oklahoma showed excellent results with a low morbidity in regards to laparoscopic dismembered pyeloplasty in children. The group states that they will consider this their primary technique for the surgical correction of ureteropelvic junction obstruction in patients older than 18 months. This study further solidifies that pediatric laparoscopic pyeloplasty has definitely entered the mainstream of surgical correction of ureteropelvic junction obstruction in children with a low morbidity and an excellent success rate. In my opinion it is slowly becoming one of the gold standards of correction. However, its widespread use is still limited by the fact that intracorporeal suturing is a daunting task. This group's first open conversion from laparoscopic pyeloplasty underscores that intracorporeal suturing is the right limiting step of this procedure. Expertise with intracorporeal suturing can only be mastered in three ways. These three ways are practice, practice, practice.

Reported by UroToday.com Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia

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