Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults

• Published in: Urology (Ridgewood, N.J.) Vol. 83; no. 4; pp. 805 - 811
• Main Authors: Garg, Manish, Singh, Vishwajeet, Sinha, Rahul Janak, Sankhwar, Satya Narayan
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2014; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Female; Humans; Hydronephrosis - congenital; Hydronephrosis - surgery; Iron Chelating Agents - chemistry; Kidney - metabolism; Laparoscopy - methods; Male; Medical sciences; Multicystic Dysplastic Kidney - surgery; Nephrology. Urinary tract diseases; Pain Measurement; Pain, Postoperative; Pentetic Acid - chemistry; Postoperative Period; Prospective Studies; Retroperitoneal Space - surgery; Treatment Outcome; Ureter - surgery; Ureteral Obstruction - surgery; Urologic Surgical Procedures - methods; Urology; Young Adult; Human; Incision; Plasty; Prospective; Nephrology; Randomization; Treatment; Surgery; Adult; Pyeloplasty; Comparative study; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2013.11.024

Objective To determine the subjective and objective outcomes of retroperitoneoscopic vs open pyeloplasty with minimal incision in a prospective randomized comparison study. Methods In this study between August 2011 to July 2013, 30 patients underwent retroperitoneal laparoscopic pyeloplasty and 30 open pyeloplasty with minimal incision (incision length <10 cm) after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Success rates were evaluated by improvement in pain score and objectively by diethylene triamine penta-acetic acid renal scan and other parameters. Statistical analysis was performed with SPSS version 16.0 (IBM) with P  <.05 considered statistically significant. Results The difference in the visual pain score (5.6 vs 3.2 on day 1; 3.8 vs 1.5 on day 2) and the diclofenac requirements (333.3 vs 178.75 mg) were statistically significant and more in the open pyeloplasty. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Success rate was found to be 96.67% with 1 failure in each group. Two patients in retroperitoneoscopic group required conversion. Both groups showed significant improvement in pain score and drainage pattern on diethylene triamine penta-acetic acid scan with decrease in hydronephrosis on ultrasound evaluation. Conclusion Although subjective and objective outcomes are equivalent in both the groups, the retroperitoneoscopic approach is associated with significantly less pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison with open pyeloplasty.