title: Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty: a single surgical team experience with 38 cases.
abstract: OBJECTIVE
  To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO).
  
  
  METHODS
  38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative DTPA (diethylene-triamine-pentaacetate) renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. Treatment success was evaluated by a 12 month-postoperative renal scan. Total success was defined as T1/2≤10 minutes while relative success was defined as T1/2between 10 to 20 minutes. Post-operative hydronephrosis and flank pain were also evaluated.
  
  
  RESULTS
  Mean operating time was 103.16±30 minutes. The mean blood loss was 122.37±73.25mL. The mean postoperative hospital stay was 4.47±0.86 days. No intraoperative complications occurred. 6 out of 38 patients (15.8%) experienced postoperative complications. The success rate was 97.4% for flank pain and 97.4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38 (2.6%) patients, relative success in 2 out of 38 (5.3%) patients and total success in 35 out of 38 (92.1%) of patients.
  
  
  CONCLUSIONS
  Laparoscopic redo-pyeloplasty is a feasible procedure for the treatment of recurrent ureteropelvic junction obstruction (UPJO), with a low rate of post-operative complications and a high success rate in high laparoscopic volume centers.
authors.affiliation: Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiancone
authors.affiliation: Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fedelini
authors.affiliation: Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pucci
authors.affiliation: Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Clemente
authors.initials: C
authors.lastname: Meccariello
authors.affiliation: Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fedelini
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Hydronephrosis; Kidney Pelvis; Laparoscopy 