Minimally Invasive Treatment of Ureteropelvic Junction Obstruction: Long-Term Experience With an Algorithm for Laser Endopyelotomy and Laparoscopic Retroperitoneal Pyeloplasty

Abstract

Laparoscopic retroperitoneal pyeloplasty yields an efficacy similar to that of open surgery. The inferior success of laser endopyelotomy even in optimally selected cases and the increasing expertise with endoscopic suturing may favor laparoscopic pyeloplasty with or without robotic assistance in the future.

The Laparoscopic Management of the Ureteropelvic Junction Obstruction: Our Initial Experience

“…The need for narcotic or nonnarcotic analgesic after in laparoscopic surgery has been found to be lower than for the open pyeloplasty technique (13). In our study, the median need for narcotic analgesics was 21.5±4.8 mg (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), which is compatible with what appears in the literature.…”

“…The most important factors that determine the success of surgery are the lack of tension in an anastomosis, good drainage, and efficient adhesiolysis. In the literature, it has been stated that the success rate of laparoscopic pyeloplasty is from 92-100% (20). Although some researchers advocate that only objective criteria would suffice, we think that the most important success criterion is symptomatic relief rather than diuretic renography and Whitaker test in follow up controls (21).…”

The Minimally Invasive Treatment of Ureteropelvic Junction Obstruction: A Review of Our Experience During the Last Decade

“…12,13 In the series by Rassweiler et al laser endopyelotomy was used with a success rate of 78.3%. 19 However, their Kaplan-Meier estimation of success included a time course that extended out to half of what we reported. Arguably with longer followup they would have realized more failures and they actually concluded at the end of their study that, even with careful patient selection, endopyelotomy was inferior to pyeloplasty in direct comparison.…”

“…Other variables that we did not evaluate which likely would have also proved significant and have also been recognized by other groups are severe hydronephrosis and preoperative renal function. 12,19,20 Other single institution comparisons of endopyelotomy and pyeloplasty for UPJO have been made. 12,13,19 However, in 2 of these reports antegrade endopyelotomy was the endoscopic method used.…”

“…12,19,20 Other single institution comparisons of endopyelotomy and pyeloplasty for UPJO have been made. 12,13,19 However, in 2 of these reports antegrade endopyelotomy was the endoscopic method used. 12,13 In the series by Rassweiler et al laser endopyelotomy was used with a success rate of 78.3%.…”