Late Failures After Laparoscopic Pyeloplasty

Objectives: We present the results of our series of 65 consecutive laparoscopic pyeloplasties, which include some unexpected late failures. Methods: We retrospectively reviewed the perioperative course of 65 consecutive patients who underwent transperitoneal laparoscopic pyeloplasty from August 1996 through July 2005 at our institution. Results: Of the obstructions, 47 and 18 were primary and secondary, respectively. Laparoscopic pyeloplasty was successfully performed on 64 patients. Of the patients, 42 (65%) had crossing vessel(s) found intraoperatively. We performed dismembered pyeloplasty for 50 (77%), Y-V plasty for 12 (18%) and Fengerplasty for 3 patients (5%). Mean laparoscopic operative time was 218 minutes, not including a mean of 40 minutes for stent placement and repositioning. The median hospital stay was 2 days. All 9 major complications (14%) pertained to urinary leakage/ureteral obstruction. Of the 60 patients with follow-up, 7 (12%) failed within 1 year of surgery. An additional 3 patients who appeared cured at initial follow-up presented with late recurrences, at 2, 2.5, and 6 years postoperatively. The overall success rate at 1 year was 88%, with a long-term success rate of 83%, and was not related to type of obstruction or repair, or urinary leakage/ureteral obstruction. Conclusions: Contrary to findings in other series, 30% of our failures occurred 2 or more years after pyeloplasty. All failures, however, were symptomatic, such that radiographic follow-up after 1 year in patients with symptoms preoperatively may not be necessary.