Background and purpose: Laparoscopic pyeloplasty (LP) has been described as the new gold standard operation for patients with ureteropelvic junction obstruction (UPJO). As life expectancy continues to increase, we will be faced with the need to counsel older patients on the risks and benefits of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open renal surgery. Avoidance of open surgery would seem particularly beneficial in elderly patients who receive a diagnosis of this condition, although results in this group have not been formally studied. We compared the perioperative and medium-term outcomes of LP for primary UPJO in patients who are 70 years and older with those who are under age 70.
Patients and methods: Between January 2006 and June 2009, 74 consecutive patients underwent LP for UPJO performed by one surgeon. A four-port extraperitoneal approach was used in all but one case. Patient demographic and perioperative data were recorded prospectively. Outcome measures were success rate at a median follow-up of 12 months, complications, and length of hospital stay.
Results: Fifteen (20%) patients were aged 70 years or older. Older patients had a higher median American Society of Anesthesiologists score (2 vs 1). Moreover, older patients often presented with compromised renal function than their younger counterparts (median split renal function on the affected kidney 35% vs 45%, serum creatinine level 130 vs 90 μmol/L, P < 0.001). The success rate in the older group was 87%, with no treatment failures in the younger patients. Median hospital stay was longer for older patients (3 days vs 2 days, P = 0.01). Frequency of complications were not significantly different between the groups; however, there was a postoperative death in an elderly patient with a solitary kidney and preoperative renal failure.
Conclusions: LP is feasible with generally good results for managing UPJO in patients 70 years or older. Older patients, however, are likely to need a longer hospital stay compared with their younger counterparts, and their co-morbidities should be carefully assessed preoperatively to minimize morbidity. Advanced chronologic age should not be a contraindication for LP in patients with symptomatic UPJO.