Tomasz Szydełko, Jarosław Kasprzak, Romuald Zdrojowy, Jerzy Lorenz
- Katedra i Klinika Urologii i Onkologii Urologicznej AM we Wrocławiu
Introduction. Laparoscopic pyeloplasty of the ureteropelvic junction (UPJ), first described by Schuessler et al. combines the success rate of open surgery with the advantages of minimally invasive procedures. Most urologists claim that laparoscopic dismembered pyeloplasty gives the best therapeutic results, no matter whether the operation is performed with a trans- or retroperitoneal approach. Some authors, however, recommend alternative laparoscopic procedures.
Objectives. A study was performed to compare the results of dismembered and nondismembered Y-V laparoscopic pyeloplasties and complications observed after the two types of surgery.
Material and methods. Ninety-one laparoscopic pyeloplasties were performed in 90 patients with ureteropelvic junction (UPJ) obstruction. A laparoscopic Hynes-Anderson pyeloplasty (LH-AP) was performed to 51 patients, a laparoscopic Y-V pyeloplasty (LY-VP) in 37 cases and Fenger plasty in 2 patients. All patients were divided into two groups on the basis of the grade of the hydronephrosis. Group one included 49 patients with hydronephrosis grade 1-2. Group two comprised 41 patients with hydronephrosis grade 3-4. Crossing vessels were observed intraoperatively in 54.5% of cases. The mean follow-up was 28.5 months. Complete success was defined as absence of any clinical symptoms combined with significant reduction of hydronephrosis on excretory urography and ultrasonography as well as no sign of obstruction on excretory urography and/or diuretic renography.
Results. The statistical analysis does not include patients after Fenger plasty as there were very few such cases in our material (two people). The mean operative time for LH-AP was 219 minutes and for LY-VP 185 minutes. The mean hospital stay after LH-AP was 5.9 days and after LY-VP 5.3 days. No serious postoperative complications were observed. The overall success rate was 96.9%. It was 98% for LH-AP patients and 94.1% for LY-VP patients. Neither the grade of the hydronephrosis nor the presence of a crossing vessel had any influence on the therapeutic results in both groups.
- The success rate of the two surgical procedures is comparable. LY-VP constitutes an attractive alternative to dismembered pyeloplasty.