Laparoscopic stentless pyeloplasty: an early experience.

INTRODUCTION

Double J stent has been an important adjunct to laparoscopic pyeloplasty. It is also associated with symptoms and significant morbidity. This study analyses the outcome of transperitoneal laparoscopic pyeloplasty without a double J stent.

MATERIALS AND METHODS

sixteen patients of ureteropelvic junction obstruction (age range: 1.5-50 yrs) were selected to undergo transperitoneal stentless laparoscopic pyeloplasty after obtaining the informed consent from August 2004 to December 2008. Ten patients were under the age of 14 years (pediatric age group). Some additional steps in the standard technique of laparoscopic pyeloplasty included anatomical spatulation of the ureter to avoid rotation, temporary splinting while suturing ureteropelvic junction and ensuring water tightness of suture line. Preoperative differential renal function, operative time, post operative complications (pain, drain output, fever), hospital stay and renal functional outcomes (Tc(99) DTPA) were recorded.

RESULTS

The median age of the pediatric age group was eight (1.5-14) years and adult group-27 (20-50) years. Median operative time was 100 min (72-140) in pediatric and 110 min (90-138) in adult group. The preoperative ipsilateral differential renal function ranged from 16-45% and 16-50% in pediatric and adult groups respectively. Five of the 10 pediatric patients had persistent leak of urine for which stenting was done in four and ureteric re-implantation in one. Only one of the six adult patients (who had secondary UPJO following Endopyelotomy) needed postoperative stenting for persistent urinary leak.

CONCLUSIONS

Though the need for postoperative stenting is high in smaller children, stentless laparoscopic pyeloplasty can be considered in adult patients with primary ureteropelvic junction obstruction.