Recurrent ureteropelvic junction obstruction following primary treatment: prevalence, associated factors, and laparoscopic treatment

Abstract

Aim: Our primary aim was to report the prevalence of recurrent stricture following primary pyeloplasty and the secondary treatment performed. The secondary aim was to identify the clinical or surgical factors related to recurrent ureteropelvic junction obstruction (UPJO). 

Materials and methods: A retrospective study was conducted on patients diagnosed with UPJO at the Hospital General de México “Dr. Eduardo Liceaga”, between 2011-2019. Patients that underwent primary pyeloplasty, and developed recurrent UPJO, underwent secondary treatment, and had follow-up ³6 months were included in the study. A descriptive analysis was carried out.

Results: A total of 52 patients underwent open or laparoscopic pyeloplasty as primary treatment and 6 of them (11.5%) presented with recurrent UPJO at 44 months (median). Two of those patients presented with a non-functioning kidney and underwent simple laparoscopic nephrectomy and the remaining 4 patients underwent transperitoneal laparoscopic redo pyeloplasty as secondary treatment. The mean age of the patients with recurrence was 46 years, their mean BMI was 32.57±5 kg/m2, and two of them had urinary diversion prior to the primary pyeloplasty. Surgery duration was longer for laparoscopic redo pyeloplasty versus primary pyeloplasty (192 minutes versus 113 minutes) and intraoperative bleeding was similar (52cc versus 52.9cc). The surgical and histologic finding in laparoscopic redo pyeloplasty was peri-ureteral fibrosis. No aberrant vessels were found. Stricture was longer than 15 mm in the patients that underwent laparoscopic redo pyeloplasty (n=4). Obesity, lithiasis, and stricture length >15mm were more frequent in the patients with recurrence. 

Conclusions: The prevalence of UPJO in our study population was 11.5%, which concurs with international parameters. Laparoscopic redo pyeloplasty is a useful tool in cases of UPJO.