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To review our experience and utilize rigorous radiologic criteria to establish success in laparoscopic pyeloplasty.The hospital records of consecutive adult patients who underwent laparoscopic pyeloplasty for ureteropelvic junction (UPJ) obstruction during a 5-year period at our institution were reviewed. We identified 47 candidates for study inclusion. With one open conversion secondary to excessive fibrosis and one patient requiring repeat laparoscopic pyeloplasty for recurrence, 46 patients with 47 renal units were included for analysis. Thirteen renal units had prior surgery for UPJ obstruction. Preoperative and postoperative symptomatology were compared to determine subjective outcome. Mercaptoacetyltriglycine (MAG3) nuclear renography was performed preoperatively and postoperatively to assess differential renal function (DRF) and obstruction, defined as a T1/2 -20 minutes, and evaluate objective success. There were 34 dismembered and 13 Y-V pyeloplasties.The mean operative time was 341.6 minutes (range 200-717 minutes). The mean preoperative T1/2 was 48.4 minutes (range 14 minutes-xc), with a mean DRF of 39.8% (range 22%-60%). The mean postoperative T1/2 was 9.32 minutes (range 2-27 minutes), and the mean DRF was 39.5% (range 7%-57%). The average length of hospital stay was 2.25 days (range 1-3 days). At a mean follow-up of 19.93 months (range 2-55 months), the subjective success rate was 95.7%, and the objective success rate was 93.6%.Even when using strict radiologic criteria to define success, laparoscopic pyeloplasty is found to be similar to open surgery in its efficacy for the correction of adult UPJ obstruction.

Open surgical correction of ureteropelvic junction (UPJ) obstruction in children is highly successful, but not without its failures. In these cases, reoperative surgery often is difficult because of the scarring associated with the prior surgery. We describe the techniques utilized for robot-assisted laparoscopic reoperative pyeloplasty in children with persistent UPJ obstruction after open surgical correction. This minimally invasive approach is a safe and effective option in the treatment of these challenging reconstructive cases.

Each of the well-established approaches to laparoscopy-standard transperitoneal, standard retroperitoneal, and transperitoneal hand-assisted-has its advantages and disadvantages. In order to maximize efficiency and patient benefit, each approach should be used selectively. This paper offers recommendations for the selective use of the hand-assisted technique, which is particularly useful when intact specimen removal is required, the surgeon has limited experience, the situation is expected to be difficult (e.g., prior surgery, fibrosis, inflammation), or the patient's other medical comorbidities mandate a rapid procedure.

Almost one-third (32%) of 221 kidneys manipulated percutaneously for calculi had had previous open procedures. Tract dilation was more difficult in these kidneys, and there was a statistically significant increase in the frequency of cases requiring multiple manipulations to rid them of calculi (14% vs. 7% in those without previous renal surgery). There also was a statistically significant difference in the number with retained stone fragments (13% vs. 8%). Although there were increases in the frequency of bleeding necessitating transfusion, procedure time, and complications, these differences were not statistically significant. We concluded that percutaneous stone removal is only minimally compromised by previous open renal surgery.