Publication:

Study of laparoscopic retroperitoneal pyeloplasty

Background Pelvi-Ureteric Junction Obstruction (PUJO) is a common anomaly seen affecting children and adults. The structural wall is most of the times the main reason for obstruction while other causes like stones, infection etc. explain the remaining. Regardless of the cause, the end result is impedance in the normal flow of urine from the renal pelvis into the proximal ureter, resulting in caliectasis and hydronephrosis. There is a scarcity of data regarding feasibility of laparoscopic retroperitoneal pyeloplasty in connotation with the Indian background. The research aims to study the procedure its feasibility, success rates and complications.

Methods This prospective study was carried out in the department of surgery of our hospital, over a period of 2 years from Nov 2011 to Nov 2013. Studies have been approved by the institutional ethics committee and Maharashtra University of health sciences, Nashik and have therefore been performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments.

Results Out of the 25 patients, there were 14 (56%) males and 11 (44%) females. Male to female ratio was 1.2:1. Of these 13 (52%) were having right sided PUJO and 12 (48%) were having left sided PUJO. 12 (48%) patients were in the age group of 16-30 years, 7 (28%) in 31-45 years age group, 5 (20%) in 0-15 years group and one (4%) patient in 46-60 years age group. 24 (96%) had history flank pain on the affected side. Of this 9 (36%) had only flank pain as there presenting symptom. 11 (44%) had history of recurrent urinary tract Infection. Only one (4%) patient had only recurrent UTI history. 8 (32%) patients had mixed symptoms most commonly associated with flank pain. 6 (24%) patients had renal lump of which 5 (20%) had associated flank pain and 1 (4%) had both UTI and flank pain. The mean VAS score for pain preoperatively is 6.54 ± 1.18. On investigation the mean serum BUL and mean serum creatinine was 36.6 ± 18.7 mg/dl and 1.1 ± 0.59 µg/dl respectively.

Conclusions Laparoscopic retroperitoneal pyeloplasty is a safe and feasible. It is associated with excellent patient outcomes with good patient satisfaction. It has direct approach to the target organ. Laying a platform this technique can also be expanded for more other procedure related to kidney and ureter.