Laparoscopic Transperitoneal Pyeloplasty Outcomes in Adult Patients with Ureteropelvic Junction Obstruction

Author(s): Md. Shahidul Islam, Anirudha Sardar, Mitheel-Ibna Islam, Md. Tarikul Islam

Background: Ureteropelvic junction obstruction (UPJO) is a frequently observed abnormality in the ureters of children. It has been reported that UPJO is approximately 5 cases per 100,000 infants each year. The obstruction at the ureteropelvic junction can be attributed to factors originating within the ureter itself (intrinsic UPJO). In contrast, cases caused by external factors are uncommon and usually result from abnormal vessels crossing the area crossing aberrant vessels.

Aim of the study: The objective of the research was to assess the results of laparoscopic Tran's peritoneal pyeloplasty in the treatment of ureteropelvic junction obstruction.

Methods: This is a retrospective study, a total of 42 patients were enrolled and analyzed. The study was conducted at the Department of Urology, Shaheed Sheik Abu Naser Specialized Hospital, and Khulna Bangladesh. The study duration was 3 years, from January 2016 to December 2019.

Result: A retrospective study analyzed 42 patients (mean age: 29.5 years) with renal abnormalities. Most had left kidney involvement (59.52%), while 40.48% had right kidney involvement. Clinical features included pain (50%), asymptomatic cases (26.19%), urinary system infections (8), and hematuria (2). The study population comprised 66.67% males and 33.33% females. The pre-operative findings showed an average operation time of 124 minutes, a bleeding amount of 38 ml, and a postoperative hematocrit level of 37.8. Most cases used the colon reflecting approach (92.86%) and the Dismembered technique (90.48%). Postoperative results showed a mean creatinine level of 0.93, a 2- 11 days hospitalization time, and a mean follow-up duration of 44 months. Complications included grade 3 (2.38%) according to Satava and Clavien classifications. Overall, 92.86% of cases were successful, with a 7.14% recurrence rate.

Conclusion: Our study identified that an elevated anterior-posterior diameter of the renal pelvis prior to surgery was associated with a higher likelihood of failure in Tran's peritoneal laparoscopy-assisted pyeloplasty. Despite the need for skilled laparoscopic skills, the procedure can be safely performed and is equally familiar as the traditional open procedure. In UPJ obstruction cases, laparoscopic pyeloplasty is a valuable alternative to open pyeloplasty.