Dismembered and non-dismembered retroperitoneoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in children

• Published in: World journal of urology Vol. 31; no. 3; pp. 689 - 695
• Main Authors: Subotic, Svetozar, Weiss, Hagen, Wyler, Stephen, Rentsch, Cyrill A., Rassweiler, Jens, Bachmann, Alexander, Teber, Dogu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2013; Springer Nature B.V
• Subjects: Adolescent; Child; Child, Preschool; Disease Management; Endoscopy - adverse effects; Endoscopy - instrumentation; Endoscopy - methods; Female; Follow-Up Studies; Humans; Infant; Laparoscopy - adverse effects; Laparoscopy - instrumentation; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - instrumentation; Minimally Invasive Surgical Procedures - methods; Nephrology; Oncology; Operative Time; Original Article; Pelvis; Retrospective Studies; Sutures; Treatment Outcome; Ureteral Obstruction - surgery; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - instrumentation; Urologic Surgical Procedures - methods; Urology; Minimal invasive; Children; Anderson-Hynes; Retroperitoneoscopic pyeloplasty; Ureteropelvic junction obstruction
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-012-0887-0

Purpose
Open dismembered pyeloplasty according to Anderson-Hynes (AHP) is the gold standard treatment for ureteropelvic junction obstruction in children. However, during the last decade, the management has been revolutionized with introduction of laparoscopy and endourology yielding comparable results and less morbid outcomes.
Methods
Between 1997 and 2010, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 41 children with a median age of 130 month (range 5–192). 20 children underwent a dismembered pyeloplasty (Anderson-Hynes) and 21 children were operated by a non-dismembered pyeloplasty (Y-V-Plasty).
Results
The mean operation time was 120 min (range 52–257). Intraoperative findings revealed in 29 cases a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 88 % with a median follow-up of 69 month (range 14–142). The 5 failures (2 Y-V-Plasty, 3 AHP) have been treated by open AHP (
n
 = 2), Laser endopyelotomy (
n
 = 2) and Lap-AHP (
n
 = 1) without further problems.
Conclusion
With increasing improvement of the suture techniques, the laparoscopic pyeloplasty represents in experienced hands an alternative method with comparable success rates to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants. We found in our series no statistically significant difference between dismembered and non-dismembered pyeloplasty.