Vol. 44 (2): 370-377, March – Abril, 2018
João Arthur Brunhara 1, Paulo Renato Marcelo Moscardi 1, Marcos Figueiredo Mello 1, Hiury Silva Andrade 1, Paulo Afonso de Carvalho 1, Bruno Nicolino Cezarino 1, Francisco Tibor Dénes 1, Roberto Iglesias Lopes 1
1 Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo – São Paulo, SP, Brasil
Objective: to assess the feasibility and outcomes of laparoscopic pyeloplasty in children with complex ureteropelvic junction obstruction (UPJO) and compare to children with iso-lated UPJO without associated urinary tract abnormalities.
Material and Methods: Medical records of 82 consecutive children submitted to trans¬peri-toneal laparoscopic pyeloplasty in a 12-year period were reviewed. Eleven cases were con-sidered complex, consisting of atypical anatomy including horseshoe kid¬neys in 6 patients, pelvic kidneys in 3 patients, and a duplex collecting system in 2 patients. Patients were di-vided into 2 groups: normal anatomy (group 1) and complex cases (group 2). Demographics, perioperative data, outcomes and complications were recorded and analyzed.
Results: Mean age was 8.9 years (0.5-17.9) for group 1 and 5.9 years (0.5-17.2) for group 2, p=0.08. The median operative time was 200 minutes (180-230) for group 1 and 203 minutes (120-300) for group 2, p=0.15. Major complications (Clavien ≥3) were 4 (5.6%) in group 1 and 1 (6.3%) in group 2, p=0.52. No deaths or early post¬operative complications such as: urinoma or urinary leakage or bleeding, occurred. The success rate for radiologic improvement and flank pain improvement was com¬parable between the two groups. Re-garding hydronephrosis, significant improve¬ment was present in 62 patients (93.4%) of group 1 and 10 cases (90.9%) of group 2, p=0.99. The median hospital stay was 4 days (IQR 3-4) for group 1 and 4.8 days (IQR 3-6) for group 2, p=0.27.
Conclusions: Transperitoneal laparoscopic pyeloplasty is feasible and effective for the management of UPJO associated with renal or urinary tract anomalies.
Keywords: Laparoscopy; Urinary Tract; Surgical Procedures, Operative