Adult Stentless Laparoscopic Pyeloplasty

BACKGROUND AND OBJECTIVES Pyeloplasty, whether open or laparoscopic, has been the mainstay of treatment for ureteropelvic junction obstruction (UPJO). A nonstented pyeloplasty has only been reported in the pediatric literature. Herein, to the best of our knowledge, we report the first published experience with laparoscopic stentless pyeloplasty (LSP) in the adult population. METHODS Patients with a normal contralateral kidney who underwent a laparoscopic pyeloplasty were included in this study. A dismembered pyeloplasty was performed without the placement of a ureteral stent. Functional Tc-99m MAG3 renal-scan data were compared with results at 4 weeks and 6 months postoperatively. Perioperative complications and long-term follow-up were prospectively gathered. RESULTS To date, 5 patients have undergone LSP with a mean follow-up of 15.7 months. Mean age and body mass index of this group were 42.8 years and 29.3 kg/m(2), respectively. Mean operative time, estimated blood loss, and hospital stay were 196 minutes, 58 mL, 1.6 days, respectively. Three patients had right-sided UPJO, and 2 patients had left UPJO. No patient had undergone previous surgery for UPJO. All patients had a ureteral stent in place at the time of surgery. No intraoperative complications occurred. Only one patient complained of flank pain on POD1. No obstruction or urinary extravasation was seen on retrograde pyelography, but a ureteral stent was placed. During our follow-up, all patients had complete resolution of their symptoms. Postoperative renal scans demonstrated improved urinary drainage in all patients. CONCLUSION Our initial experience suggests that in experienced hands, LSP may be an effective method for treating UPJO.