title: Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction: long-term results.
abstract: OBJECTIVE
  To evaluate the long-term results of laparoscopic pyeloplasty in patients with secondary ureteropelvic junction obstruction after failed primary interventions.
  
  
  METHODS
  Between August 2000 and October 2012, transperitoneal dismembered laparoscopic pyeloplasty was carried out in 13 patients with a surgical history of failed prior surgical interventions. Perioperative outcomes as well as long-term results were assessed. These outcomes were compared with those of the same procedure carried out for primary ureteropelvic junction obstruction by a single surgeon during the same study period.
  
  
  RESULTS
  Laparoscopic transperitoneal pyeloplasty was completed successfully in all cases without converting to open surgery or requiring blood transfusion. The preoperative symptoms in 12 of 13 patients all disappeared soon after the operation. Asymptomatic severe hydronephrosis found in a 2-year-old boy reduced in size postoperatively. When comparing the primary with the secondary laparoscopic pyeloplasty carried out by the same surgeon, the mean operative time was longer (183 vs 241 min, P = 0.002), estimated blood loss was larger (33 vs 66 mL, P = 0.03) and the complication rate was higher (8.8% vs 22.2%, P = 0.01) in the secondary group. Success rates were 97.9% and 100% (P = 0.41) at a mean follow up of 25.9 and 40.0 months (P = 0.14) for the primary and secondary groups, respectively.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty is an excellent option for patients who failed previous surgical management. This approach provides durable long-term outcomes comparable with those of primary treatment for ureteropelvic junction obstruction.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Morihiro
authors.initials: M
authors.lastname: Nishi
authors.forename: Mayumi
authors.initials: M
authors.lastname: Tsuchida
authors.forename: Masaomi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsuda
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology; D007682:Kidney Pelvis / Q000002:abnormalities / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult
keywords: laparoscopy; long-term; pyeloplasty; result; secondary