Evaluation of different surgical modalities in the management of pelvi-ureteric junction obstruction: a randomized controlled trial

Background and aim Pelvi-ureteric junction obstruction (PUJO) disrupts kidney drainage. Open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) are common surgical interventions. Comparative evaluations aim to assess their efficacy, complications, and outcomes, guiding optimal PUJO management. Patients and methods This study conducted at the Urology Department, Al-Azhar University Hospitals in Egypt, from March 2018 to February 2023 included 40 patients with PUJO. Patients were divided into open and LP groups. Inclusion criteria comprised individuals aged from 7 months to 60 years, of any sex, diagnosed with PUJO and having a glomerular filtration rate more than 10 ml/min. Operative details and postoperative outcomes were assessed, providing valuable insights into PUJO management. Statistical analysis was performed using SPSS, version 27.0. Results Both groups were well-matched, with no significant differences in age, sex, laterality, or presentation. Preoperative assessments revealed comparable hydronephrosis severity and renal function. Operative complications were nil in 100% of open cases and 90% in laparoscopic cases, P =0.250, with one (10%) case experiencing JJ migration. The laparoscopic group had a significantly longer median operative time (167.50 vs. 60 min), P value less than 0.001, but notably shorter hospital stays (3 vs. 5 days), P value less than 0.001. Postoperative complications, urinary analysis, imaging findings, and treatment success rates were comparable between groups, suggesting similar postoperative outcomes. Conclusion Both OP and LP boast success rates of ∼90%. LP, despite being more time-consuming, presents lower morbidity and fewer complications than OP, maintaining similar functional outcomes.