title: Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children: Safety and Efficacy of the Technique.
abstract: Failure after pyeloplasty for ureteropelvic junction obstruction in children may occur in up to 10% of cases. Therapeutic options include Double-J® stent placement, endoscopic treatment and reoperation. Laparoscopic and robotic reoperative modalities seem safe and efficacious, although pediatric series are limited in the literature. We report the largest known series of reoperative laparoscopic ureteropelvic junction obstruction repair in children and compare this approach to primary laparoscopic pyeloplasty.
  
  
  
  We reviewed all children undergoing laparoscopic pyeloplasty at a single institution from 2004 to 2015. Reoperative laparoscopic ureteropelvic junction obstruction repair was compared to primary pyeloplasty. Groups were analyzed regarding demographics, operative time, complications, length of hospital stay and success, defined by improvement of symptoms, ultrasound and renogram.
  
  
  
  We identified 11 cases of reoperation (8 redo pyeloplasties and 3 ureterocalycostomies) and 71 primary pyeloplasties. Groups were not different in age, gender or weight. Median followup was 37 months. Median time between primary pyeloplasty and reoperation was 34 months. Median operative time was 205 minutes for the reoperative group and 200 for primary pyeloplasty (p = 0.98). Length of stay was longer in the reoperative group (p = 0.049), although no major complications were recorded in this group. All reoperative cases and 96% of primary pyeloplasty cases remained asymptomatic following surgery (p = 0.99). Postoperative improvement was similar for both groups on ultrasound (90% for reoperation vs 92% for primary pyeloplasty, p = 0.99) and renogram (80% vs 88%, p = 0.6).
  
  
  
  Laparoscopy seems to be safe and effective for management of failed pyeloplasty in children. Based on our data, reoperation is as safe and effective as primary pyeloplasty.
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Paulo Renato Marcelo
authors: PR
authors: Moscardi
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: jbrunhara@gmail.com.
authors: João Arthur Brunhara Alves
authors: JA
authors: Barbosa
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Hiury Silva
authors: HS
authors: Andrade
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Marcos Figueiredo
authors: MF
authors: Mello
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Bruno Nicolino
authors: BN
authors: Cezarino
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Lorena Marçalo
authors: LM
authors: Oliveira
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Miguel
authors: M
authors: Srougi
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Francisco Tibor
authors: FT
authors: Dénes
authors: Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Roberto Iglesias
authors: RI
authors: Lopes
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: kidney pelvis; laparoscopy; reoperation; ureteral obstruction; urologic surgical procedures