Results of Laparoscopic Pyeloplasty Depending on the Method of the Upper Urinary Tract Drainage

Abstract The aim of the study was to analyze the results of laparoscopic pyeloplasty depending on the method of the upper urinary tract drainage. Introduction. To date, laparoscopic pyeloplasty is widely used for the treatment of ureteropelvic junction obstruction. But the issue of the optimal method for drainage of the upper urinary tract during laparoscopic surgeries has not been resolved yet. Material and methods. 532 patients were selected. The mean age of the patients was 25.8 ± 12.6 years. All patients were divided into 3 groups: Group I - 108 (20.3%) patients who had a nephrostomy and ureteral stent installed during laparoscopic pyeloplasty; Group II - 188 (35.3%) patients who were performed only an ureteral stent; Group III - 236 (44.3%) patients who had a nephrostomy and ureteral intubator installed through the skin. Results. The shortest duration of surgery was observed in the group of patients with a ureteral stent (92.5 ± 10.9 minutes versus 125.1 ± 23.0 minutes and 124.0 ± 12.6 minutes; p < 0.05). The lowest intensity of postoperative pain on the 1st day was observed in the group of patients with ureteral stent (4.7 ± 1.2 versus 6.2 ± 1.0 and 6.2 ± 0.9). The method of the upper urinary tract drainage also did not affect the duration of inpatient treatment (on average 3.7 ± 0.7 days). The incidence of postoperative wound suppuration (2.7-3.0%), mild plexopathy (3.7-3.8%), hematuria (7.4-11.1%) and exacerbation of urinary tract infection (8.9-12.2%) did not differ statistically between the groups (p>0.05). Discussions. In our study, dysuric phenomena when using only stents were observed in 32.9% of cases; when installing a nephrostomy and a ureteral stent – in 28.7%, and when draining with a nephrostomy and an intubator – in 1.7% of cases. In Group I, despite the use of a ureteral stent, the presence of nephrostoma significantly reduced the frequency of urinoma formation. Additional interventions had to be performed to treat this complication (percutaneous nephrostomy, stent replacement or nephrostomy)or laparoscopy with repeated formation of the anastomosis was performed, as it was in 2 (1.1%) patients from Group II and in 1 (0.4%) patient from Group III. Conclusions. The installation of a nephrostomy or ureteral stent after laparoscopic pyeloplasty is equally effective for the upper urinary tract drainage. Although the ureteral stent requires less time to install and is associated with less traumatism, it has the most postoperative complications requiring additional interventions.

Hali tarjima qilinmagan