Laparoscopic management of pelvi-ureteric junction obstruction after failed open surgery or Laparoscopic pyeloplasty in adults

Document Type : Original Article


1 Department of Urology and Reproductive Medicine, Faculty of Medicine, Sohag University.

2 Department of Urology and Reproductive Medicine, Faculty of Midicine, Sohag University.


Objectives: a prospective study of our experience and midterm results of laparoscopic pyeloplasty (LP) for patients who have failed open or Laparoscopic pyeloplasty in adults.
Patients and methods: Thirty two patients with failed open pyeloplasty were reviewed; all of them had transperitoneal dismembered LP. All procedures were performed by experienced laparoscopist during a period of two years.
Results: The study group consisted of 14 men and 18 women with the mean age of 29± 6 years. Mean operative time was 123± 22 minutes. Mean hospital stay was 4.7 ± 2.3 days. Mean follow-up was 5.6 ± 2.15 months (range 3-9 months). The overall success rate for secondary LP was 90.6%. There was no conversion to open surgery. Intraoperative and postoperative complications were 9.4 and 12.5% respectively.
Conclusions:LP is a safe and viable treatment option for secondary pelviureteric junction obstruction with high success rate but with long operative time. A good experience in laparoscopic reconstructive procedures is a prerequisite for optimal results.

  1. Schuessler WW1, Grune MT, Tecuanhuey LV, Preminger GM.: Laparoscopic dismembered pyeloplasty. J Urol 1993; 150:1795–1799.
  2. Levin BM, Herrell SD: Salvage Laparoscopic Pyeloplasty in the Worst Case Scenario: After Both Failed Open Repair and Endoscopic Salvage. J End 2006:20,808-812
  3. Anderson JC, Hynes W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol 1949; 21: 209-14.
  4. Ng CS, Yost AJ, Streem SB. Management of failed primary intervention for ureteropelvic junction obstruction: 12-year, single-center experience. Urology. 2003; 61: 291-6.
  5. Jabbour ME, Goldfischer ER, Klima WJ, Stravodimos KG, Smith AD.: Endopyelotomy after failed pyeloplasty: the long-term results. J Urol. 1998; 160:690-2; discussion 2-3
  6. 6 Dindo D, Demartines N, Clavien PA. Classification of surgical complication: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg.2004; 240: 205–13.
  7. Persky L, McDougal WS, Kedia K. Management of initial pyeloplasty failure. J Urol 1981; 125: 695–7.
  8. Rehman J, Landman J, Sundaram C, Clayman RV.:. Missed anterior crossing vessels during open retroperitoneal pyeloplasty: laparoscopic transperitoneal discovery and repair. J Urol 2001; 166: 593–6.
  9. Motola JA, Badlani GH, Smith AD: Results of 212 consecutive endopyelotomies: an 8-year followup. J Urol 1993; 149: 453–6.
  10. Preminger GM, Clayman RV, Nakada SY, et al.: A multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and ureteropelvic junction obstruction. J Urol 1997; 157: 1625-9.
  11. Rohrmann D1, Snyder HM 3rd, Duckett JW Jr, Canning DA, Zderic SA.: The operative management of recurrent ureteropelvic junction obstruction. J Urol 1997; 158: 1257–9.
  12. Thomas JC1, DeMarco RT, Donohoe JM, Adams MC, Pope JC 4th, Brock JW 3rd: Management of the failed pyeloplasty: a contemporary review. J Urol. 2005;174: 2363-6.
  13. Lim DJ, Walker RD. 3rd: Management of the failed pyeloplasty. J Urol 1996; 156:738–40.
  14. Piaggio LA, Noh PH, González R. Reoperative laparoscopic pyeloplasty in children: Comparison with open surgery. J Urol 2007; 177: 1878–82.
  15. Basiri A1, Behjati S, Zand S, Moghaddam SM.: Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction after failed open surgery. J Endourol 2007; 21:1045–51.
  16. Shadpour P, Haghighi R, Maghsoudi R, Etemedian M: Laparoscopic redo pyeloplasty after failed open surgery. J Urol 2011; 8:31–7.
  17. Sundaram CP, Grubb RL, 3rd, Rehman J, et al: Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction. J Urol 2003; 169:2037–40.
  18. Nakada SY, Mcdougall EM, Clayman RV: Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction: preliminary experience. Urology1995; 46: 257–60.
  19. Gettman MT, Neururer R, Bartsch G, Peschel R: Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology 2002; 60:509–13.
  20. Autorino R, Eden C, El-Ghoneimi A et al.: Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: A systematic review and meta-analysis. Eur Urol 2014; 65: 430-452.
  21. Atug F, Burgess SV, Castle EP, Thomas R: Role of robotics in the management of secondary ureteropelvic junction obstruction. Int J Clin Pract 2006; 60: 9–11.
  22. Hemal AK, Mishra S, Mukharjee S, Suryavanshi M: Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair. Int J Urol 2008; 15: 744–6.
  23. Lindgren BW1, Hagerty J, Meyer T, Cheng EY: Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option. J Urol 2012; 188: 932–7.
  24. Niver BE1, Agalliu I, Bareket R, Mufarrij P, Shah O, Stifelman MD: Analysis of robotic-assisted laparoscopic pyeloplasty for primary versus secondary repair in 119 consecutive cases. Urology 2012; 79:689–94.