Redo laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction: a single center experience and a review of the literature.

Abstract

Backround: To describe and analyze our experience with secondary (redo) laparoscopic pyeloplasty (rLP) in managing recurrent ureteropelvic junction obstruction (UPJO) following primary pyeloplasty, and to compare our outcomes with those reported in the existing literature.

Methods: A retrospective analysis was conducted on patients who underwent rLP for recurrent UPJO. Baseline characteristics, detailed histories of previous pyeloplasties, operative profiles, and follow-up data were collected and analyzed. Furthermore, a comprehensive literature review was performed using PubMed.

Results: The study included eight patients (four men, four women) with a mean age of 27 years who underwent rLP. Among them, three had left-side and five had right-side involvement. Three patients had undergone open pyeloplasty, three laparoscopic pyeloplasty, one robot-assisted pyeloplasty, and one laparoscopic pyeloplasty and failed salvage endopyelotomy. Recurrent UPJO etiologies were recurrent stenosis (five cases), fibrosis and adhesions (two cases), and a combination of fibrosis, adhesions, and high insertion (one case). No crossing vessels were involved. Seven patients were treated using the dismembered technique, and one with Y-V plasty. The mean operation time was 185 min (range 150-240), and all procedures were completed laparoscopically. No blood transfusions were required intra- or postoperatively. The mean hospital stay was 2.8 days (range 2-4). Two patients (25%) experienced postoperative complications (one Clavien grade II and one Clavien grade IIIa). The mean follow-up period was 39 months (range 18-78), with a success rate of 87.5%.

Conclusions: This study contributes additional evidence that rLP is an effective and reliable treatment for secondary UPJO, achieving high success rates despite its technical challenges.