Comparison of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Adults and Children: Lessons Learned

• Published in: The Journal of urology Vol. 185; no. 4; pp. 1461 - 1468
• Main Authors: Kojima, Yoshiyuki, Umemoto, Yukihiro, Mizuno, Kentaro, Tozawa, Keiichi, Kohri, Kenjiro, Hayashi, Yutaro
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2011; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Aged; Biological and medical sciences; Child; Child, Preschool; Humans; Infant; kidney pelvis; Kidney Pelvis - surgery; Kidneys; Laparoscopy; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; ureteral obstruction; Ureteral Obstruction - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures - methods; Urology; Young Adult; laparoscopy; ureteral obstruction; ultrasonography; body mass index; diuretic renography; UPJO; DR; UPJ; AP; anteroposterior; kidney pelvis; ureteropelvic junction obstruction; adult; ureteropelvic junction; US; child; BMI; Human; Kidney disease; Endoscopic surgery; Nephrology; Urinary system disease; Ureteral obstruction; Ureteral disease; Laparoscopic surgery; Laparoscopy; Urinary tract disease; Pyeloplasty; Kidney; Urology; Hydronephrosis; Treatment; Urinary system; Adult; Pyeloureteral junction obstruction; Endoscopy; Child; Comparative study
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2010.11.048

Purpose We compare the technical details and surgical outcomes of adult and pediatric laparoscopic pyeloplasty, and discuss the lessons learned from these comparisons. Materials and Methods A total of 46 patients underwent laparoscopic pyeloplasty for repair of ureteropelvic junction obstruction between August 2006 and April 2010. Patients were divided into 2 groups—adults (older than 16 years, 21 patients) and children (15 years or younger, 25 patients). Medical records and surgical videos were reviewed with particular attention to patient characteristics, procedures and surgical outcomes. Results Crossing vessels were more common in adults (p <0.05). After June 2009 we tried to perform a transmesenteric approach for left ureteropelvic junction obstruction, and actually performed this procedure for 3 of 5 adults (60%) and 8 of 10 children (80%). There was no significant difference in median operative times between adults and children. However, mean time required for exposure of the ureteropelvic junction in children (54 minutes) was less than that in adults (81 minutes, p <0.005). Mean time required for ureteropelvic anastomosis tended to be longer in children. Postoperative complications were noted in 3 adults and 1 child. Percentage reduction in anteroposterior diameter of the renal pelvis was significantly greater in children than in adults (p <0.05). Successful resolution of ureteropelvic junction obstruction was observed in 90.0% of adults and 95.5% of children. Conclusions Understanding of the key surgical steps of adult and pediatric laparoscopic pyeloplasty can provide for the improvement of laparoscopic skills, and facilitate procedures in adult and pediatric populations.