Estimation of the results of laparoscopic pyeloplasty in primary strictures of the pelvic-ureteral segment.

Abstract

Introduction. In 1993, W.W. Schuessler et al. laparoscopic pyeloplasty was reported, and since that time the number of interventions performed with such access has increased significantly. Laparoscopic pyeloplasty does not exclude possible complications, including early ones - urinary congestion, anastomosis failure and distant ones, restenosis and obliteration of the ureteral lumen, which can develop as a result of ischemia due to excessive tissue tension. There are isolated references in the literature about the positive effect of prestenting on the results of pyeloplasty. Objective. Estimate the results of laparoscopic pyeloplasty in patients without prestenting and with prestenting. Materials and methods. A retrospective analysis of the treatment of 73 patients with stricture of the pelvic ureteral segment is presented. All patients were divided into two groups: I (main) – 17 patients whose upper urinary tract was drained by a ureteral stent at the time of surgery, II (control) - 56 patients who had not previously had upper urinary tract drainage. Results. The results, nature and frequency of complications of laparoscopic pyeloplasty in patients with and without prestenting are analyzed. The average operation time in group I was about 153.85 minutes, in group II - 116.7 minutes, the average drainage time in group I was 22.1 hours, in group II - 30.8 hours. Requirement for analgesics: group I – 48.5 mg/day, group II – 56.2 mg/day. In group I, one complication (5.9%) of category 1 was recorded - an attack of pyelonephritis and one case of complications (5.9%) of category 3a (urinoma). In group II, 6 cases (10.7%) of category 1 complications, 9 cases (16.1%) of category 3a complications were recorded. The results according to MSCT, performed 3 months after surgery, demonstrated restoration of patency at the level of the ureteropelvic segment. Conclusions. Prestenting of the ureter reduces the frequency of postoperative complications during laparoscopic pyeloplasty and eliminates the need for additional mobilization of the kidney for the formation of ureteropyeloanastomosis without excessive tension.