Management of ureteropelvic junction obstruction in an era of minimally invasive surgery

Introduction

In an era of minimally invasive surgery, laparoscopic pyeloplasty has emerged as an alternative to conventional open pyeloplasty. Although the open method boasts a success rate of over 90%, laparoscopic pyeloplasty far exceeds patient satisfaction due to its low perioperative morbidity. The aim of this study was to evaluate the outcome of patients who underwent laparoscopic pyeloplasty due to congenital ureteropelvic junction obstruction (UPJO). Material and Methods A retrospective observational study was conducted at Sri Jayawardenapura general hospital from March 2014 to December 2020. All patients were subjected to CT urogram and diuretic renogram (DTPA) scan. Clinical, imaging and biochemical findings were recorded. Patients included were those who underwent laparoscopic pyeloplasty based solely on the clinical severity of the disease, those who underwent lap-nephrectomy or open surgery was excluded. Follow up was based on clinical and DTPA scan findings. Improvement in symptomatology, split renal function(SRF) by 5% and/or diuretic curve pattern were considered successful outcomes. Results A total of 40 patients who underwent LP were evaluated with a mean age of 32 years and slight male preponderance. The majority (82.5%) were symptomatic with pain and/or infection. All were diagnosed with hydronephrosis with impaired DTPA. An SRF < 40% in the affected kidney was observed in 22(55%) of patients. Concomitant pyelolithotomy was performed in 7(17.5%) patients. Mean hospital stay was 3.5 days. At mean follow up of 22-months, improvement in symptoms were noted in 35(87.5%) patients and SRF improvement (>5%) were noted in 11(27.5%); the function remained stable in 27(67.5%) and deteriorated in 2(5%) of patients. Discussion Although LP is technically demanding, it offers excellent symptomatic relief and renal preservation. It offers less morbidity, better aesthetic and post-operative convalescence: a promising viable option replacing open surgery.