We present the results of our series of 65 consecutive laparoscopic pyeloplasties, which include some unexpected late failures.

We retrospectively reviewed the perioperative course of 65 consecutive patients who underwent transperitoneal laparoscopic pyeloplasty from August 1996 through July 2005 at our institution.

Of the obstructions, 47 and 18 were primary and secondary, respectively. Laparoscopic pyeloplasty was successfully performed on 64 patients. Of the patients, 42 (65%) had crossing vessel(s) found intraoperatively. We performed dismembered pyeloplasty for 50 (77%), Y-V plasty for 12 (18%) and Fengerplasty for 3 patients (5%). Mean laparoscopic operative time was 218 minutes, not including a mean of 40 minutes for stent placement and repositioning. The median hospital stay was 2 days. All 9 major complications (14%) pertained to urinary leakage/ureteral obstruction. Of the 60 patients with follow-up, 7 (12%) failed within 1 year of surgery. An additional 3 patients who appeared cured at initial follow-up presented with late recurrences, at 2, 2.5, and 6 years postoperatively. The overall success rate at 1 year was 88%, with a long-term success rate of 83%, and was not related to type of obstruction or repair, or urinary leakage/ureteral obstruction.

Contrary to findings in other series, 30% of our failures occurred 2 or more years after pyeloplasty. All failures, however, were symptomatic, such that radiographic follow-up after 1 year in patients with symptoms preoperatively may not be necessary.