title: Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies?
abstract: OBJECTIVE
  To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2).
  
  
  METHODS
  The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared.
  
  
  RESULTS
  Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42).
  
  
  CONCLUSIONS
  The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable.
authors.affiliation: Department of Urology, Lakeshore Hospital, Kochi, India.
authors.forename: George P
authors.initials: GP
authors.lastname: Abraham
authors.forename: Krishanu
authors.initials: K
authors.lastname: Das
authors.forename: Krishnamohan
authors.initials: K
authors.lastname: Ramaswami
authors.forename: Avinash T
authors.initials: AT
authors.lastname: Siddaiah
authors.forename: Datson P
authors.initials: DP
authors.lastname: George
authors.forename: Jisha J
authors.initials: JJ
authors.lastname: Abraham
authors.forename: Oppukeril S
authors.initials: OS
authors.lastname: Thampan
mesh_terms: D000328:Adult; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications* / Q000601:surgery*; D055815:Young Adult