ENDOUROLOGY & LAPAROSCOPY

Retrospective Comparison of Retroperitoneal Laparoscopic Versus Open Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction
Zhang X, Li HZ, Ma X, Zheng T, Lang B, Zhang J, Fu B, Xu K, Guo XL
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People’s Republic of China
J Urol. 2006; 176: 1077-80

• Purpose: We evaluated the clinical value of retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction compared with open surgery.
• Materials and methods: The clinical data of 56 patients who underwent retroperitoneal laparoscopic dismembered pyeloplasty were retrospectively compared with those of 40 patients who underwent open dismembered pyeloplasty through a retroperitoneal flank approach. The Student t test, Pearson chi-square test and Mann-Whitney rank sum test were applied for statistical analysis as appropriate.
• Results: Patient demographic data were similar between the 2 groups. In the laparoscopic group operative time (80 vs 120 minutes), estimated blood loss (10 vs 150 ml), recovery of intestinal function (1 vs 2 days), analgesic requirements (diclofenac sodium suppository) (75 vs 150 mg), incision length (3.5 vs 21 cm) and postoperative hospital stay (7 vs 9 days) were better than in the open group (p <0.001 for all). No intraoperative complications occurred in either group. The incidence of postoperative complications (2 of 56, 3.6% vs 3 of 40, 7.5%, p = 0.729) and success rates (55 of 56, 98.2% vs 39 of 40, 97.5%, p = 0.058) were equivalent in the 2 groups.
• Conclusions: Retroperitoneal laparoscopic dismembered pyeloplasty is a minimally invasive, safe and effective therapy for ureteropelvic junction obstruction with low morbidity, shorter convalescence and excellent outcomes, and can be accomplished reasonably quickly in experienced hands.
  
  
• Editorial Comment
  The new era of reconstructive surgery demonstrates the evolvement of minimally invasive approaches to the Ureteropelvic junction (UPJ) repair. In a retrospective study, the authors compared the retroperitoneal laparoscopic dismembered pyeloplasty technique to the open pyeloplasty approach with comparable results and complication rates. Significant difference between both techniques included blood loss and incision length. Moreover, Dr. Winfield discussed in his editorial comment “Management of Adult Ureteropelvic Junction Obstruction - Is it Time for a New Gold Standard?” (J. Urol, 176, September 2006, 866-867 ) the diversity of different surgical techniques available to repair the UPJ obstruction but caution to report post-operative success should be critically evaluated:1) objectively (nuclear renal lasix scan) and 2)subjectively (pain free post-op).

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA