title: Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction.
abstract: OBJECTIVE
  Open dismembering pyeloplasty has high success rates but is associated with significant morbidity and moderate cosmetic results. Aim of this study was to evaluate laparoscopic dismembering pyeloplasty compared with other laparoscopic techniques and open surgery in this respect.
  
  
  METHODS
  Between September 1999 and September 2002 we performed 25 laparoscopic dismembering (LDP), 15 laparoscopic non-dismembering (LNDP) and 15 open pyeloplasties (ODP) in 55 patients. For laparoscopy two 12 mm and two 5mm ports were used, a ureteric stent remained in place for 4 weeks. ODP was performed via a flank incision, a percutaneous ureteric stent and a nephrostomy remained for 10 days. Postoperative morbidity was assessed by visual analogue scale (VAS). Mean follow-up was 23.4+/-9.1 months (range 7-42) for laparoscopy vs. 21.9+/-8.8 (range 9-41) months for open surgery. Success was evaluated with postoperative i.v. pyelogram or diuretic nephrography.
  
  
  RESULTS
  A crossing vessel could be identified in 82.5% (33/40) with laparoscopy vs. 47.0% (7/15) in ODP. Postoperative VAS score was lower in the laparoscopic group (day 1 3.5+/-1.6 vs. 5.4+/-3.1, day 5 0.9+/-1.2 vs. 3.1+/-1.8, p=0.001). Length of skin incision was 4.1+/-0.7 vs. 23.8+/-9.1 cm and hospital stay was 5.9+/-2.1 vs. 13.4+/-3.8 days for laparoscopy and ODP respectively. Success rate was 96.0% (24/25) for LDP, 73.3% (11/15) for LNDP and 93.4% (14/15) for ODP. Two patients with LNDP and one with ODP required re-operation. Clot retention was observed in two with LDP and one with ODP. Two abdominal wall herniations and one thromboembolism occurred with ODP.
  
  
  CONCLUSIONS
  Short-term results demonstrate that dismembering laparoscopic pyeloplasty has the same success rates as open surgery but morbidity and complications are significantly decreased. Non-dismembering techniques have the least favourable results. This finding may suggest that LDP has the potential to replace open surgery as the gold standard for treatment of uretero-pelvic junction obstruction.
authors.affiliation: Department of Urology, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. christoph.klingler@uro.akh.magwien.gv.at
authors.forename: H Christoph
authors.initials: HC
authors.lastname: Klingler
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Guenter
authors.initials: G
authors.lastname: Janetschek
authors.forename: Christian
authors.initials: C
authors.lastname: Kratzik
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Marberger
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*