Application of Strict Radiologic Criteria to Define Success in Laparoscopic Pyeloplasty

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.