title: Matched comparison of primary versus salvage laparoscopic pyeloplasty.
abstract: OBJECTIVE
  To compare our experience with salvage laparoscopic pyeloplasty, using a matched control set of primary laparoscopic pyeloplasty patients.
  
  
  METHODS
  We retrospectively reviewed patients who underwent laparoscopic pyeloplasty from 1996 to 2014 by a single surgeon. At least 12 months of follow-up was required. Salvage patients were matched 1:3 with primary patients. Matching was based on age ±5 years, body mass index (BMI) ±5, and type of pyeloplasty (dismembered vs. non-dismembered). Primary outcome was failure as defined as re-intervention following laparoscopic pyeloplasty (does not include temporary stenting without definitive retreatment).
  
  
  RESULTS
  Of 128 laparoscopic pyeloplasty procedures, ten were salvage. These patients were matched to 26 patients who underwent a primary laparoscopic pyeloplasty in a 1:3 manner. One salvage pyeloplasty failed to match due to BMI, and the closest matches were made. Four salvage patients had one overlapping match, reducing the primary group to 26 patients. There were no differences in pre-, intra-, and postoperative variables between groups, except for operative time (salvage 247 min, primary 175 min, p = 0.03). With similar duration of radiologic and symptomatic follow-up, there was no significant difference in the rate of freedom from intervention.
  
  
  CONCLUSIONS
  When matching for factors that could affect success, salvage laparoscopic pyeloplasty performed as well as primary pyeloplasty except for a longer operative time. In experienced hands, salvage laparoscopic pyeloplasty for ureteropelvic junction obstruction recurrence after prior pyeloplasty is a safe and effective procedure, and should be considered an excellent alternative to the more commonly recommended endopyelotomy.
authors.affiliation: Department of Urology, University of Michigan Health System, 1500 E. Medical Center Dr., TC 3875, Ann Arbor, MI, 48109-5330, USA. sapan@med.umich.edu.
authors.forename: Sapan N
authors.initials: SN
authors.lastname: Ambani
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Yang
authors.affiliation: Department of Urology, University of Michigan Health System, 1500 E. Medical Center Dr., TC 3875, Ann Arbor, MI, 48109-5330, USA.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000074643:Nephrotomy; D016016:Proportional Hazards Models; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Laparoscopic; Pyeloplasty; Salvage; Secondary; Ureteropelvic junction obstruction