Comparison of Flank, Dorsal Lumbotomy and Laparoscopic Approaches for Dismembered Pyeloplasty in Children Older Than 3 Years With Ureteropelvic Junction Obstruction

Purpose: Selecting a surgical approach for correction of ureteropelvic junction obstruction in children is mostly driven by surgeon preference, and includes laparoscopy, flank incision and dorsal lumbotomy. Comparative analyses focusing on operative time, hospital stay and complications are lacking. Materials and Methods: We retrospectively reviewed the charts of 41 consecutive patients older than 3 years who underwent laparoscopic pyeloplasty by a single surgeon between 2005 and 2008. We compared these cases to 67 age matched cases managed by flank incision (42) or dorsal lumbotomy (25). We evaluated age at surgery, operative time, performance of retrograde pyelogram, length of hospitalization and complication/failure rates. Results: Mean patient age was 7.3 to 8.1 years. Mean operative time was significantly longer for laparoscopy (178 minutes) compared to flank incision (144) and dorsal lumbotomy (148, p = 0.01). Mean hospital stay was significantly shorter for laparoscopy (2.3 days) compared to flank incision (3.6) and dorsal lumbotomy (3.3, p = 0.01). Complications occurred in 4 laparoscopic, 2 flank incision and 2 dorsal lumbotomy procedures. Patients who underwent laparoscopic pyeloplasty had a significantly shorter mean followup (28 months) compared to flank incision (49) and dorsal lumbotomy (47, p = 0.02). Conclusions: Overall complication rates were not significantly different for the 3 pyeloplasty approaches. For the evaluated outcomes our data do not favor one particular surgical access over others in children older than 3 years.