Early outcome findings of treatment for transperitoneal laparoscopy-assisted pyeloplasty

Abstract

Background We retrospectively analyzed the initial results of laparoscopic pyeloplasty, among pediatric patients undergoing the procedure by transperitoneal access. Methods We retrospectively reviewed the medical records of patients who were operated with transperitoneal laparoscopy-assisted pyeloplasty at our institution between 2015 and 2020. Results The mean age of the 51 patients (M/F = 36/15) was 59 ± 49.8 months. The mean preoperative renal pelvis anterior–posterior diameter was 32.9 ± 13.4 mm, and the relative renal function was 42 ± 12.1% on the operation side. Forty-three (84.3%) patients had no excretion on MAG3 examination preop. The number of patients with no excretion decreased to 10 (19.7%) after surgery. One of them underwent a successful endopyelotomy; eight of them underwent a successful laparoscopic re-pyeloplasty. There was nothing to do in only one patient whose DRF decreased to 11%. The mean anterior posterior diameter decreased significantly to 16.7 ± 11.2 mm after surgery (p < 0.001). Conclusion Preoperative increased renal pelvis anterior–posterior diameter detected in our study was found to be a risk factor in the failure of transperitoneal laparoscopy-assisted pyeloplasty procedure.

Can We Predict Renal Function Recovery After Pyeloplasty in Pediatrics with Ureteropelvic Junction Obstruction? A Systematic Review

“…Four studies agreed that APD could potentially predict the success of pyeloplasty. 18 , 19 , 26 , 29 A higher preoperative APD was associated with a higher probability of surgery failure. 15 , 18 Despite the presence of studies supporting the effect of APD, 3 studies found that APD had no significant effect on the outcomes of pyeloplasty.…”

“…This result is more interesting because more studies have shown no difference between the recovery of renal function based on age at diagnosis (pre and postnatal). 19 - 21 Salem et al 22 showed that the overall likelihood of reduced or improved preoperative DRF becoming reduced or improved in the postoperative period is not affected by age. All studies that explored the correlation between gender and results of pyeloplasty found that no association exists between the 2.…”

“…All studies that explored the correlation between gender and results of pyeloplasty found that no association exists between the 2. 19 - 21 , 23 - 25 …”

“…Another study also revealed that a 40-mm APD could be a risk of failure in patients receiving a laparoscopic approach. 19 Society for fetal urology hydronephrosis grade was also one of the factors associated with pyeloplasty outcomes. In children with congenital hydronephrosis, SFU grade has been shown to be correlated with renal function, in which a higher grade indicates decreased DRF preservation.…”

“…This study is also in line with several more studies that showed no difference between the recovery of renal function based on age at diagnosis (pre and postnatal). 19 - 21 On the contrary, Nodenstrom et al 18 showed that patients who were antenatally detected had a better catch-up or improvement in DRF. Onen et al 34 and Ulman et al 35 presented cohorts of individuals with an average age at surgery of 5-6.5 months and claimed DRF recovery after pyeloplasty compared to the mean age of 20 months; however, they did not report how many patients had a DRF improvement of >5.…”