Urological management of ureteropelvic junction obstruction: single centre analysis

Introduction

Pelviureteric junction obstruction (PUJO) describes a functionally significant impairment of urinary transport from the renal pelvis to the ureter. Although most cases are congenital, the problem may not become clinically apparent until much later in life. Acquired conditions such as stone disease, postoperative or inflammatory stricture, or urothelial neoplasm may also manifest clinically with symptoms and signs of obstruction at the level of the UPJ. Open and laparoscopic approaches are available for treatment of PUJO, both have their own advantage and disadvantage

Aim of study: To compare the Technical difficulties, Operative duration, Post op complications, duration of hospital stay, and long term outcomes.

Material method

Retrospective and prospective data analysis done for patient admitted with PUJO to whom transperitoneal laparoscopic or ANDERSON HYNE Dismembered pyeloplasty done in dept. of urology Govt ROYPETTAH hospital in last 3 years, data is compared on basis of age group, post-operative complication, drain removal, duration of stay in hospital. Total no of cases were 18 for open pyeloplasty and laparoscopic pyeloplasty was 10. Inclusion criteria for open and lap pyeloplasty were decided.Assessment of success rate Based on pt. symptom score, follow up USG, and follow up DTPA /IVU renal function are assessed on basis of DPTA /DMSA scan and biochemical parameter. All patients were adult.

Results

Males are commonly affected than females. No redo plasty done for both group, success rate is equal in both group, the postoperative analgesic requirement was significantly less in Laparoscopic group compared to open group. The postoperative hospital stay in LP was mean 10.4 Days in open group compare to laparoscopic group 7.4 days which is significantly less than open group mean There was minimal or no scarring of the wound site in patients in the laparoscopic group compared to open. The success rate of laparoscopic pyeloplasty and open group is equal, the only disadvantage seems to be longer operative time and require high learning curve in laparoscopic series.

Conclusion

Laparoscopic pyeloplasty is a technically sound operation which uses well established principles. The advantages of open pyeloplasty are lesser operating times. Success rate are favourable in both group, the only disadvantage of Laparoscopic pyeloplasty is longer operative time and requires significant skill of intracorporeal knotting. Laparoscopic pyeloplasty procedure has a minimal level of morbidity, short hospital stay, better cosmetics compared to open approach. Laparoscopic pyeloplasty has emerged as the standard of care for all pyeloplasty