[Retroperitoneoscopic assisted pyeloplasty for ureteropelvic junction obstruction in children]. / Pieloplastia asistida por retroperitoneoscopia: nuestra experiencia en 30 pacientes.

ABSTRACT

OBJECTIVES: Description of the retroperitoneoscopic approach in the conventional pyeloplasty for ureteropelvic junction obstruction in children. MATERIAL AND METHODS: From 1998 pyeloplasty assisted by retroperitoneoscopic approach (PARA) was performed in 30 patients. TECHNIQUE Position in latero-dorsal decubitus and incision of 1 cm in angle costolumbar. We made retroperitoneoscopic space by ball dissection technique and 11 mm Hg pressure. The ureteropelvic junction was extracted through the incision of the port. The UPJ was resected in all patients and Anderson-Hynes pyeloplasty with double PDS 6/0 continuous sutures was performed. In all patients a drainage type Penrose in perirenal space was used. In the last 18 patients a 4F double-J stent was placed. The mean follow-up time was 42 months (range between 6 and 84 months). Operative time, hospital stay, handling of postoperative pain and the postoperative studies have been revised. RESULTS: In all the cases the retroperitoneoscopic approach was good for the identification and dissection of the ureteropelvic junction facilitating the extraction and reconstruction (pyeloplasty) through the mini-incision of the entrance port. The mean operative time was 90 min. (range between 65 and 128 min). We highlight the absence of intraoperative complications. The only postoperative complication has been a pyohydronephrosis in a patient not having internal drainage that was solved by percutaneous pyelostomy and didn't need reintervention. The postoperative handling of the pain was good by means of caudal locorregional anesthesia or by infiltration of the wound with local anesthesic and a dose of Ibuprofeno previous to leave the hospital. The mean hospital stay was 2 days (1-3 days) excluding the complicated case. Postoperative diuretic renograms at the 6 and 18 have shown absence of obstruction in all cases. In the long term follow-up, in 1 case nephrectomy was performed. CONCLUSIONS: The PARA for UPJ obstruction is a safe and effective procedure with the advantage of a minimal invasive approach that facilitates the reconstruction of the ureteropielic junction. Reduces operative time and hospital stay, with appropriate postoperative results. In our experience PARA constitutes an alternative to the conventional pyeloplasty and laparoscopic pyeloplasty in the pediatric age.