Primary versus rescue laparoscopic ureterocalicostomy for complex upper urinary tract obstruction: a single-center series with long-term follow-up.

PURPOSE: To compare perioperative and long-term outcomes of laparoscopic ureterocalicostomy (UC) performed as a primary-versus-rescue reconstruction after failed prior repair in complex upper urinary tract obstruction.

METHODS

We retrospectively reviewed a prospectively maintained single-institution database of 24 patients who underwent laparoscopic UC between January 2008 and August 2024; UC was decided intraoperatively when conditions precluded safe pyeloplasty. The comparison was restricted to primary ureteropelvic junction obstruction (n = 23): rescue UC after failed prior repair (n = 12) versus primary UC without previous repair (n = 11). Demographics, operative data, complications, split renal function (DTPA scintigraphy), serum creatinine/eGFR, and symptom resolution were compared between and within groups.

RESULTS

The cohort was predominantly adult (33% younger than 18). The two groups were comparable in age, symptom duration, operative time, blood loss, and hospital stay (all p > 0.4). Pre- and postoperative split renal functions were comparable between groups (p = 0.35 and p = 0.97) and remained stable within both groups (40.0 ± 20.6% to 43.2 ± 18.5% overall). There were no conversions and only minor complications. At a median follow-up of 60 months, 22 of 24 patients (91.6%) achieved resolution of the obstruction. The two adverse outcomes were one primary failure (excluded patient, nephrectomy) and one late recurrence at 18 months. At last follow-up, 22 of 24 patients (91.6%) had durable resolution of the obstruction. There were two adverse outcomes of different nature: one primary failure (the excluded patient, who never improved and required nephrectomy) and one late recurrence in the primary group, in a patient with initial resolution who restenosed at 18 months; both related to complex calyceal anatomy.

CONCLUSION

Laparoscopic UC provided durable long-term resolution of obstruction whether performed as a primary or a rescue reconstruction. UC is a reliable option in both unoperated and redo settings when pyeloplasty is unsafe, provided that calyceal anatomy is carefully assessed.