Laparoscopic Pyeloplasty: Technique, Morphological and Functional Outcome in Uretero-Pelvic Junction Obstruction

Introduction: UPJO is defined as an anatomic or functional impedance of urine flow from the renal pelvis into the ureter. UPJO is caused by a congenital intrinsic narrowing of the lumen or by external compression[1,2].The surgical treatment for UPJO includes laparoscopic pyeloplasty,open pyeloplasty,endopyelotomy, endopyeloplasty and robot assisted laparoscopic pyeloplasty.[6] Laparoscopic Pyeloplasty is now considered a standard treatment for UPJO and has a success rate of about 90% with less invasiveness. [6,7] In some of the studies, success rate of laparoscopic pyeloplasty is approaching 99-100% and so is being considered as Gold standard.[6,18] Aims and Objectives:In the present study,we evaluated the morphological and functional outcomes of laparoscopic dismembered pyeloplasty for the management of unilateral UPJO. Materials and Methods:We retrospectively reviewed the clinical charts of all patients subjected to laparoscopic dismembered pyeloplasty( 20 cases) in the department of General Surgery at SMIMER Hospital( Tertiary care Centre ),Surat between the period of January 2014 to December 2019. Record of all patients were assessed for demographic profile ,co morbidities ,routine blood investigations, including RFT, urine cytology and culture sensitivity, specialised investigation as X ray KUB,USG KUB,IVP/CT-IVU,DTPA. Results: We performed Laparoscopic dismembered Pyeloplasty in 20 Patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 5 patients. No complications or conversion to open surgery was seen in any case. There was a 100 % primary overall success rate. In our study, 5 patients were evaluated for DTPA scan preoperatively and same group was evaluated postoperatively after 1 year. The average SFR in such patients improved from 33.2 % to 42.4% in one year. Also, 95% of the renal units showed an improvement, and 5% no change in parenchymal thickness. No post-operative complications were reported.