Intraoperative and postoperative outcomes of laparoscopic pyeloplasty for managing recurrent ureteropelvic junction obstruction. A single institutional analysis of 38 patients

Francesco Chiancone1, Maurizio Fedelini1, Clemente Meccariello1, Luigi Pucci1, Daniele Mattace Raso1, Domenico Di Lorenzo1, Paolo Fedelini1
  • 1 AORN A. Cardarelli, U.O. C. Urologia (Napoli)


Open redo pyeloplasty is still considered the gold standard for managing recurrent ureteropelvic junction obstruction. With the advent of video-laparoscopy, minimally invasive redo pyeloplasty has become a realistic alternative to redo open pyeloplasty, even if this approach is still anecdotal in literature (1). The aim of this study was to describe our single surgical team experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO).

Materials and Methods

We enrolled 38 consecutive patients whose underwent transperitoneal laparoscopic redo pyeloplasty between January 2007 and January 2015 at our department. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative renal scan. In all cases a transperitoneal pyeloplasty using the Anderson-Hynes technique was performed, by a single surgical laparoscopic team (2). Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. All patients underwent a periodical clinical and radiological follow-up. Treatment success was evaluated by a 12 months postoperative renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Descriptive statistics of categorical variables focused on frequencies and proportions. Means and standard deviation were reported for continuously coded variables.


Mean stricture length was 0,99±0,45 cm (range, 0,2-2,2 cm) on IVU or retrograde pyelography.
Mean operating time was 103,16±30 minutes. The mean blood loss was 122,37±73,25 ml. The mean postoperative hospital stay was 4,47±0,86 days. No intraoperative complications occurred according the Satava system (3). 6 out of 38 patients(15,8%) experienced postoperative complications according Clavien-Dindo classification (4) (Table 1). The success rate was 97,4% for flank pain and 97,4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38(2,6%) patients, relative success in 2 out of 38(5,3%) patients and total success in 35 out of 38(92,1%) of patients. The radiologic failure, occurred in the patient that experienced the urine leakage. The patient underwent a laparoscopic pyeloplasty at our hospital for the third time with relative success at post-operative DTPA renal scan.


Laparoscopic redo pyeloplasty is considered a very challenging procedure due to the possibility to find a lot of peripelvic and periureteric fibrosis. Moreover some adjuvant maneuvers may be required to success, like the use of a pelvis flap or ureterocalicostomy (5). The high rate of success in our series can be related to the short length of the failed stenosis without the need for additional challenging maneuvers. In the most complex cases we need to perform the isolation of all kidney and distal ureter in order to perform a tension free anastomosis and to avoid the twisting of the anastomosis. Some limitations of the study herein include, firstly, the short follow-up time. Another limitation is that all procedures were performed by a single surgical team with significant expertise in laparoscopic surgery, which may restrict the generalizability of our results to centers with more limited laparoscopic experience. Moreover this is a retrospective observational non-comparative study.


Laparoscopic redo pyeloplasty is a feasible procedure for the treatment of recurrent UPJO, with a low rate of post-operative complications and an high success rate in high laparoscopic volume centers.


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2- Fedelini P, Verze P, Meccariello C, Arcaniolo D, Taglialatela D, Mirone VG. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases. J Endourol. 2013;27:1224-9.

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5- Ross JH, Streem SB, Novick AC, Kay R, Montie J. Ureterocalicostomy for reconstruction of complicated pelviureteric junction obstruction. Br J Urol. 1990;65:322-5.