Recurrent UPJ obstruction following laparoscopic pyeloplasty

Introduction: A dismembered pyeloplasty is the most preferred technique to correct uretero pelvic junction obstruction. The present study was undertaken to identify the reasons for recurrent (Ureteropelvic junction) UPJ obstruction following laparoscopic pyeloplasty and analyse the outcome following repeat surgery. Materials and Methods: We retrospectively reviewed the outpatient and inpatient records of children ≤ 18 years of age, having undergone surgery for UPJ obstruction and presenting later with symptoms of recurrent obstruction. Results: A total of 36 children presented with recurrent UPJ obstruction following laparoscopic pyeloplasty. Twenty-one of these were males and the remaining 15 were females. Eight (22.2%) children underwent a repeat laparoscopic pyeloplasty, 23 (63.8%) underwent an Open pyeloplasty and 5 (13.8%) underwent an open ureterocalicostomy. A diuretic renogram repeated 3 months after removal of double J ureteric stent showed significant improvement in the urinary drainage on the affected side leading to improvement in split renal functions. In 17 (47.2%) children the excised UPJ sent for histopathological examination showed complete obliteration with no evidence of patency of the UPJ junction, suggesting a faulty suturing technique to be the cause of the recurrent UPJ obstruction. Conclusion: Recurrent UPJ obstruction following laparoscopic pyeloplasty is known and can be due to either faulty suturing technique, non-dependent drainage or recurrence of stricture/narrowing at the UPJ. Early diagnosis of recurrent obstruction helps in early salvage of the renal unit and improvement of the renal function.