To Evaluate The Clinical Efficacy Of Retroperitoneal Laparoscopic Pyeloplasty For Ureteropelvic Junction Obstruction(UPJO)in 24 Children

Objective:To evaluate the clinical efficacy of retroperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction(UPJO)in children.Methods:Select 24 pediatric patients with UPJO,18 boys and 6 girls,15 left and 9 right, the age ranged from 5.2~12.5 years, mean 6.4 years. All patients had radiographic evidence of obstruction(IVU、MRU、CTU),Mild in 4 cases, 18 cases of moderate and severe hydronephrosis 2 cases. There were 23 cases with junction obstruction and 1 case with crossing vascular compression. Retroperitoneoscopic dismembered pyeloplasty for pediatric ureteropelvic junction obstruction was performed in all 24 cases. D-J stentings were inserted antegradely but 2 cases who turned to external drainage.Results:No case was turned to open surgery. The average operating time was 125 min(ranging92~165 min), average blood loss was 75 m L(ranging 51~102 ml), All cases began eating 1 day after operation, and Perirenal drain was removed at mean postoperative1~3 day, and 1 case suffered urine leakage, was cured by extend the indwelling time(10 days) of drainage tube. Urethral catheters were keep for 5~7 days. Thepostoperative hospital stay time ranged from 6 to 16 day(mean 8.6 d). D-J tubes were taken out by ureteroscopes postoperation 4~6 weeks. Ureteral stent tubes and pelvis draining tubes were removed two weeks later in 2 cases suffered external drainage,and draining incision were healing by vaseline yarn obturation and change of dressing.During the follow-up of 6~36(average 16) months, all patients demonstrated improved drainage with no evidence of obstruction on diuretic renography and the hydronephrosis relieved obviously in all patients by B-ultrasound and IVU, at the same time, the clinical symptoms disappeared among these cases. No patients required to rehospitalization owing to anastomotic stoma stenosis or hydronephrosis.ConclusionsRetroperitoneoscopic dismembered pyeloplasty is a safe,effective and mini-invasive procedure for pediatric ureteropelvie junction obstruction,with a rapid postoperative recovery, although the operation time is longer and expenditure is more. External drainage is complex, but it does not need to take out of the D-J tubes by cystoscopes or ureteroscopes. So it will be the effective treatment for UPJO in pediatric patients and worthy to be extended of clinical.