Laparoscopic pyeloplasty of the pyeloureteral segment: our experience

The OBJECTIVE of the study was to analyze the results and to introduce our experience of the laparoscopic pyeloplasty regarding the stricture of the pyeloureteral segment.

METHODS and MATERIALS. Our study represents results of treatment of 114 patients who had surgical treatment during the years 2013–2018. In that period, we made 114 primaries and 9 secondaries laparoscopic pyeloplasties with transperitoneal access. In this account, there were 43 men aged from 19 to 64 years, average age was (34.9±3.7), and 71 women aged from 19 to 77 years, average age was (39.2±4.2). All patients underwent ultrasound examination of the kidneys on the day of discharge and 3-5 days after stent extraction. Control examination, which included history taking, examination, clinical and biochemical blood analyses, clinical urine analysis and ultrasound of the kidneys were performed after 3 months. Plain and excretory urography were performed 6 and 18 months after surgical intervention. 

RESULTS. Operative removal of the stricture of the pyeloureteral segment was successful in 105 (92.2 %) out of 114 cases. 9 patients (7.8 % of the total number of operated patients) underwent repeated laparoscopic pyeloplasty. Duration stay after primary laparoscopic pyeloplasty was from 3 to 5 days, on average (3.9±0.7) days. Postoperative period after secondary pyeloplasty was without complications, the bed-day was from 3 to 6 days, on average (4.3±0.6) days.

CONCLUSION. Our opinion is that the optimal method for surgical treatment of patients with primary and secondary strictures of the pyeloureteral segment is laparoscopic pyeloplasty. This kind of surgery has a favorable security profile and optimal postoperative results. Considering the possible causes of relapse of the stricture of the pyeloureteral segment, we came to the conclusion that the frequency of relapse is mainly connected with selected suture material, which determines the severity of scar changes.

1. Helin I., Persson P. H. Prenatal diagnosis of urinary tract abnormalities by ultrasound // Pediatrics. 1986;78(5):879–883.

2. Sizonov V. V. Diagnostika obstrukcii pieloureteral’nogo segmenta u detej // Vestnik urologii. 2016;(4):57–58. (In Russ.).

3. Al’-SHukri A. S., Nevirovich E. S., Ignashov YU. A. Laparoskopicheskaya pieloplastika chrezbryzzheechnym dostupom sleva: nash opyt // Urologicheskie vedomosti. 2015;5(2):10–12. (In Russ.).

4. Schuessler W. W., Grune M. T., Tecuanhuey L.V., Preminger G. M. Laparoscopic dismembered pyeloplasty // J. Urol. 1993;150(6):1795– 1799.

5. Komyakov B. K., Guliev B. G., Aliev R. V. Laparoskopicheskaya pieloplastika // Urologiya. 2014;(1):79–83. (In Russ.).

6. Alyaev Yu. G., Glybochko P. V., Pushkar’ D. YU. Rossijskie klinicheskie rekomendacii // Urologiya. Moscow, GEOTAR-Media, 2015:480. (In Russ.).

7. Antonov A. V. Vnebryushinnyj endovideohirurgicheskij dostup k organam zabryushinnogo prostranstva // Urologicheskie vedomosti. 2012;2(3):35– 41. (In Russ.).

8. Das S., Amar A. D. Ureteropelvic junction obstruction with associated renal anomalies // J. Urol. 1984;(131):872–874.

9. Antonov A. V. Endovideohirurgicheskoe vosstanovlenie prohodimosti pieloureteral’nogo segmenta // Urologicheskie vedomosti. 2013;3(3): 33–38. (In Russ.).

10. Antonov A. V. Endovideohirurgiya v urologii: terminologiya, istoriya, pokazaniya, vozmozhnosti, oslozhneniya // Urologicheskie vedomosti. 2012;2(1):42–48. (In Russ.).

11. Komyakov B. K., Guliev B. G., SHibliev P. F. Endoskopicheskie vmeshatel’stva pri strikturah verhnih mochevyvodyashchih putej // Pervyj Rossijskij kongress po endourologii: Materialyu (Moscow, 4–6 iyunya 2008). Moscow, 2008:183–185. (In Russ.).

12. Stern J. M., Park S., Anderson J. K. et al. Functional assessment of crossing vessels as etiology of ureteropelvic junction obstruction // Urology. 2007;(69):1022–1024.

13. Guliev B. G., Aliev R. V. Oslozhneniya laparoskopicheskoj pieloplastiki po klassifikacii Klav’ena // Eksperimental’naya i klinicheskaya urologiya. 2016;(2):47–51. (In Russ.).

14. Elbaset M. A., Osman Y., Elgamal M., Sharaf M. A. et al. Long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction in adults associated withrenal congenital anomalies: Age, sex and renal function matched analysis // Arab Journal of Urology. 2020;(18):6. Doi: 10.1080/2090598X.2020.1816600.

15. Sorokin I., O’Malley R. L., McCandless B. K., Kaufman R. P. Successful Outcomes in Robot-Assisted Laparoscopic Pyeloplasty Using a Unidirectional Barbed Suture // J Endourol. 2016;30(6):660–664.

16. Jacobs B. L., Lai J. C., Seelam R., Hanley J. M., Wolf J. S. et al. The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction // Urology. 2018;(111):72–77.