[Laparoscopic pyeloplasty in recurrent ureteropelvic junction obstruction].

Introduction: Pyeloplasty represents main treatment method of patients with primary ureteropelvic obstruction (UPJ). In recurrent UPJ obstruction endopyelothomy is performed more commonly and in case of its failure a repeated pyeloplasty can be done. The aim of the study was to assess the results of laparoscopic pyeloplasty in these recurrent cases.

Materials And Methods: A total of 178 laparoscopic pyeloplasty was performed in urologic clinic from February 2010 to March 2018. In 18 patients (10.1%), including 11 men and 7 women, recurrent UPJ obstruction was diagnosed. Mean age was 36.5+/-8.0 years. There were 12 left UPJ obstruction and 6 right UPJ obstruction. Previously, 10 and 8 patients undergone open and laparoscopic pyeloplasty, respectively. Retrograde pyelothomy was done in 12 cases (75.0%). All patients had clinical symptoms and obstructive curve pattern on dynamic scintigraphy. Intra- and postoperative complications were graded using Clavien classification. The results of laparoscopic pyeloplasty were evaluated by excretory urography and dynamic scintigraphy.

Results: There was no conversion. Mean duration of laparoscopic pyeloplasty was 105.5+/-28 min. The surgery was more prolonged in patients who previously undergone transperitoneal laparoscopic pyeloplasty. Conversely, laparoscopic pyeloplasty after failed open retroperitoneal pyeloplasty was less complicated. Mean blood loss was 60.0+/-20.5 ml. There was no intraoperative complications and postoperative complications developed in 3 patients (16.7%), including fever in 2 cases (grade II on Clavien) and urinary leakage in 1 patient (grade I on Clavien). Laparoscopic pyeloplasty was ineffective in 1 case (5.4%), according to dynamic scintigraphy.

Conclusion: Laparoscopic pyeloplasty is feasible method in case of recurrent UPJ obstruction despite scar tissue in the area of intervention.