Comparative Analysis Of Complications After Open Pyeloplasty And Laparoscopic Pyeloplasty In Children With Congenital Ureteropelvic Junction Obstruction

Objective: To investigate differences analysis of complications after Open pyeloplasty(OP)and laparoscopic pyeloplasty(LP)in children with hydronephrosis by ureteropelvic junction obstruction(UPJO).And to further provide clinical evidence with treatment children,s hydronephrosis by UPJO in applying OP or LP.Methods: The medical records of 458 cases of "Children,s ureteropelvic junction obstruction" were recruited from August 2006 to December 2019 in our hospital.Among of them,320 cases UPJO with unilateral hydronephrosis were retrospectively analyzed.Of the 320 patients,239 cases had undergone Open pyeloplasty(OP)and 81 had undergone laparoscopic surgery(LP).Among 239 cases with OP(69 cases in the first 3 years during receptiving OP),age ranged from 17 days to 14 years with a median age of 2.3 years(male 125 and female 114,left 148 and right 91),17 cases less than 1 year old,186 cases from 1 year to 6 years old and 23 cases older than 6 years.Among 81 cases receptiving LP in the first 3 years from 2016 to 2019,age ranged from 8 months to 13 years with a median age of 3.5 years(male 45 and female 36,left 51 and right 30),3 cases less than 1year old,73 cases from 1 year to 6 years old and 5 cases older than 6 years.To see doctor for UPJO with hydronephrosis by prenatal examination or physical examination,waist and abdomen pain,or abdominal mass.To select part of auxiliary examinations for all cases in diagnosis as follows:B-ultrasound,Intravenous Urography(IVU),Single-photon emission computed tomography radionuclide renal dynamic imaging(SPECT),Magnetic Resonance Urography(MRU)or Computed Tomography Urography(CTU),Retrograde Pyelography(RP)or Voiding Cystourethrography(VCUG)with very severe or giant hydronephrosis and so on.To diagnosis unilateral(left / right)UPJO by selection auxiliary examinations before Anderson-Hynes(A-H)surgery operation with moderate and severe renal pelvis dilatationand evaluate degrees of renal function damage.Renal fistula tubes,support tubes and perirenal drainage tubes were routinely indwelled in patients with OP whereas Double "J" tubes and perirenal drainage tubes were routinely placed in LP.Renal functions such as serum creatinine(Cr)and urea nitrogen(BUN)before A-H surgery operation were normal in all cases,no abnormal urine routine and no urinary tract infections.Among of them,all sorts of complications occurred after A-H surgery operation.Results: 239 cases of all cases,postoperative complications in OP were as follows: 23 cases with re-obstruction after OP,leaking urine of resection pelvis or ureteropelvic anastomosis in 31 cases,urinary tract infection 23 cases,low back pain and hematuria in15 cases,transient complications after anesthesia such as headache and vomiting in 29 cases.Postoperative complications of LP in 81 cases were as follows: 11 cases with re-obstruction after LP,leaking urine of resection pelvis or ureteropelvic anastomosis in 5cases,urinary tract infection 7 cases,low back pain and hematuria in 17 cases,intestinal obstruction in 3 cases,transient complications after anesthesia such as headache and vomiting in 17 cases,subcutaneous emphysema and omentum expose in 5 cases.Statistical analysis were follows: there were no significant difference between OP and LP with re-obstruction,leaking urine of resection pelvis or ureteropelvic anastomosis and urinary infection after A-H surgery operation(P> 0.05).Whereas there were significant difference between OP and LP with transient complications after anesthesia such as headache and vomiting,low back pain and hematuria after A-H surgery operation(P<0.05).So is also like statistical results between OP and LP with all kinds of complications after A-H surgery operation in 1 to 6 years old group.It is not suitable for statistical analysisin in less than 1 year and older than 6 years due to fewer cases with fewer complications.There were not significantly difference between OP and LP with all kinds of complications during the first 3 years in executiving Anderson-Hynes(A-H)surgery operation(P> 0.05)but there were more complications in LP.Conclusion: It is unavoidable for complications to executive Anderson-Hynes(A-H)surgery operation with children,s hydronephrosis by UPJO.Re-obstruction and urine extravasation are main complications that affect the prognosis of UPJO after A-H surgery operatio and are related to the choice of surgical procedure.In the initial stage of A-H surgery operation,OP is the best surgical procedure whereas LP is the best surgical procedure for patients older than 1 year with hydronephrosis by UPJO.