Division of Urology, Dept. of Surgery
Characterizing the safety, effectiveness, and patient population of laparoscopic pyeloplasty for ureteropelvic junction obstruction: A Canadian single-centre, single-surgeon experience
Hark Randhawa1, Yuding Wang1, Melissa McGrath1,2, Luis H. Braga1,2,3.
1Department of Surgery, Urology , McMaster University , Hamilton , ON, Canada; 2McMaster Pediatric Surgery Research Collaborative, McMaster University , Hamilton, ON, Canada; 3Health, Evidence and Impact , McMaster University , Hamilton, ON, Canada
Introduction: Laparoscopic pyeloplasty(LP)remains an optimal treatment for pediatric patients with UPJO.While open and robot-assisted laparoscopic are feasible depending on patient and health systems factors,LP confers decreased morbidity compared to open, and is an important skill for urologists in health systems where access to robotic technology may be limited. We aim to describe the safety, effectiveness, and clinical characteristics of patients undergoing LP at our tertiary pediatric centre.
Methods: We performed a retrospective review of prospectively collected data on pts undergoing LP between 2008-2020 at a single centre by one surgeon. Outcomes of interest included operative time(OT),complication rates,and pre-operative clinical characteristics such as symptoms and diagnostic findings.Trends were explored by dividing the patient subset into tertiles,andoutcomesbetween groups were compared withStudent’s ttests.
Results: 154 ptsunderwent LP with retrograde pyelogram(RPG)109(71%)pts were symptomatic preoperatively, the majority of whom either had pain(44%)or UTI(19%)Preoperatively, the mean APD was27∓12.1mm and among117pts undergoing renography,meant1/2 was 75mins(128).RPG and intra-operative findings revealed that 58(38%)pts had an intrinsic obstruction,51(33%)had crossing vessels,and45(29%)had UPJO from other etiologies(e.g., polyps).Mean OT was 214 mins(59)among the whole cohort.There was no statistically significant difference in OT between the first and second tertiles(228vs. 235mins),but there was a difference between the third tertile compared to the prior two(180 mins, p<0.001).On average,pts were7.5years of age at the time of operation;11pts were≤1year of age,25 were between1-3years,and 118pts were>3 years.In total, 5 ptsneeded a repeat operation,3(1.9%)were diagnosed with UTI postoperatively,2(1.3%)developed a urinoma,and4(2.6%)had omental protrusion at the time of drain removal.The overall complication ratewas9.1%,and the highest number of complications was seen in older pts(64%occurred in those>3 years).
Conclusions: Lowcomplication and re-operation rates,make LP an effective procedure with minimal associated morbidity,which can be performed safely in children<1 year.