Excision of the Dilated Pelvis is not Necessary in Laparoscopic Dismembered Pyeloplasty

Abstract

Purpose: The surgical treatment of choice for significant hydronephrosis is dismembered pyeloplasty. While in open surgery, extensive resection of the dilated pelvis is common practice, laparoscopically usually only a sparing resection is performed. We compared the treatment results of both techniques to investigate whether extensive resection is necessary or not in dismembered pyeloplasty procedures. Methods: To obtain comparable renal units, matched pairs according to age and relative kidney uptake as shown by ¹²³J-orthoiodohippurate renography were selected out of a total of 76 patients who underwent dismembered pyeloplasty between 2000 and 2007. Twenty-four patients complied with the criteria for inclusion in the study. Changes in urinary drainage preoperatively and at three months postoperatively were compared between both groups. Results: The mean age in the sparing resection group was 3.8 years (range 0.3 to 14 years); in the extensive resection group it was 3.4 years (range 0.5 to 10 years). Mean urinary drainage improved significantly in both groups from 35.1 ± 10.7 % to 75.2 ± 13.2 % (sparing resection) vs. 45.1 ± 23.7 % to 70.2 ± 22 % (extensive resection). There were no differences between the groups (p > 0.05). Conclusions: We conclude that extensive resection of the renal pelvis is not necessary in dismembered pyeloplasty procedures since there were no differences in the renographic outcome of comparable patients treated by the different surgical methods.

Key words

dismembered pyeloplasty - children - laparoscopy - ¹²³J‐orthoiodohippurate renography

References

• 1 Bonnard A, Foquet F, Carricaburu E, Agrai Y, El-Ghoneimi A. Retroperitoneal laparoscopic versus open pyeloplasty in children.  J Urol. 2005;  173 1710-1713
• 2 Diamond D A, Nguyen H T. Dismembered V-flap pyeloplasty.  J Urol. 2001;  166 233-235
• 3 Eichel L, Khonsari S, Lee D I, Eichel L, Khonsari S, Lee D I, Basillote J, Shanberg A, Duel B, McDougall E M, Clayman R V. One-knot pyeloplasty.  J Endourol. 2004;  18 201-204
• 4 Metzelder M L, Kuebler J, Petersen C, Glüer S, Nustede R, Ure B M. Laparoscopic nephroureterectomy in children: a prospective study on Ligasure™ versus clip/ligation.  Eur J Pediatr Surg. 2006;  16 241-244
• 5 Metzelder M L, Schier F, Petersen C, Truss M, Ure B M. Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age.  J Urol. 2006;  175 688-691
• 6 Peters C A, Schlussel R N, Retik A B. Pediatric laparoscopic dismembered pyeloplasty.  J Urol. 1995;  153 1962-1965
• 7 Reddy M, Nerli R B, Beshetty R, Ravish I R. Laparoscopic dismembered pyeloplasty in children.  J Urol. 2005;  174 700-702
• 8 Siqueira Jr T M, Nadu A, Kuo R L, Paterson R F, Lingemann J E, Shalav A L. Laparoscopic treatment for ureteropelvic junction obstruction.  Urology. 2002;  60 973-978
• 9 Stein R, Ikoma F, Salge S, Miyanaga T, Mori Y. Pyeloplasty in hydronephrosis: examination of surgical results from a morphologic point of view.  Int J Urol. 1996;  3 348-355
• 10 Streem S B. Ureteropelvic junction obstruction: open operative intervention.  Urol Clin North Am. 1998;  25 331-341
• 11 Tripathi M, Kumar R, Chandrashekar N, Sharma S, Bal C, Bandopadhyahya G, Malhotra A. Diuretic radionuclide renography in assessing Anderson-Hynes pyeloplasty in unilateral pelviureteric junction obstruction.  Hell J Nucl Med. 2005;  8 154-157
• 12 Vodopija N. Minimally invasive methods in treatment of pyeloureteral stenosis.  Coll Antropol. 2003;  27 77-81