INTRODUCTION AND OBJECTIVES: Open dismembered pyeloplasty is usually performed through flank, anterior subcostal or posterior lumbotomy incisions. These incisions are cosmetically less acceptable and may produce significant postoperative pain. Accordingly we developed a new open surgical approach through which open dismembered pyeloplasty performed with a single small incision, shorter hospital stay and no need to postoperative use of analgesics.

METHODS: Between November 2003 and November 2008, 1154 children with ureteropelvic junction obstruction (UPJO) were referred to our center. From these 373 children (mean age: 4 months) with hugely dilated pelvises underwent miniature pyeloplasty. The exact place of incision was determined by intraoperative renal ultrasonography. The incision was made along the most dependent part of the lower quadrant with muscle fibers splitting. After meticulous dissection of ureteropelvic junction component, the affected section was pulled out and underwent classic dismembered pyeloplasty without renal pelvis reduction. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded for further evaluation.

RESULTS: The operation was successful in all patients. The mean operative time was 53 minutes (range 43 to 75) and patients were discharged after 18±3 (Mean ± SD) hours. Incision size was 11 to 15 mm. No narcotic supplementation was required postoperatively and there were no complications during follow up.

CONCLUSIONS: Miniature Pyeloplasty is a safe and successful treatment choice for UPJO with shorter operation time and negligible postoperative pain in compare with the classic open pyeloplasty. The exact incision site must be reconfirmed intra-operatively by physical examination or renal ultrasonography.

Source of Funding: none