Laparoscopic pyeloplasty for pediatric UPJO: Clinical outcomes from five Arabian Gulf tertiary centers over ten years

Introduction Ureteropelvic junction obstruction (UPJO) is frequently identified in infancy due to routine prenatal screening. While many cases resolve, true obstructions require surgery to preserve renal function. Laparoscopic pyeloplasty has increasingly replaced open surgery, even in infants, though optimal timing and approach remain debated. Objective We report a 10-year multicenter experience with laparoscopic pyeloplasty in children across five tertiary centers in three Arabian Gulf countries. Study design A retrospective review of 422 patients (459 renal units) who underwent laparoscopic pyeloplasty from January 2014 to January 2024 was conducted. Demographic data, clinical presentation, investigative findings, surgical indications, intraoperative findings, and outcomes were retrieved from electronic records. Data were tabulated and examined for statistical significance. Results Mean age at surgery was 38 ± 46 months; 152 were <6 months and 230 < 12 months. Transperitoneal pyeloplasty was used in 443 renal units, retroperitoneoscopic in 16. Aberrant vessels (5.9 %), retrocaval ureters (0.4 %), and other anomalies (2.8 %) were identified. Seven patients had prior failed pyeloplasty (mostly open). Conversion to open surgery occurred in 2 cases (<1 %); no intraoperative complications were reported. Mean operative time was 209 ± 67 min, decreasing significantly over time (p < 0.001). Nine patients (2.6 %) required redo pyeloplasty. Ultrasound outperformed MAG3 in predicting failure (sensitivity/specificity: 94 %/100 % vs 91 %/90 %). Discussion Laparoscopic pyeloplasty has become increasingly accepted, including for infants, as surgical expertise and familiarity with minimally invasive techniques have improved. Our multicenter series of 459 renal units represents one of the largest reported and affirms the safety and efficacy of laparoscopic pyeloplasty across a broad patient population. A substantial proportion of our patients were treated early in life, with 36 % under 6 months and 55 % under 12 months. Although younger age was historically considered a limitation, our findings support previous reports that younger infants can be safely and effectively managed laparoscopically in experienced hands. This study is limited by its retrospective nature and lack of a comparator group undergoing open pyeloplasty. However, as the field moves forward, future studies will likely focus on comparative outcomes between laparoscopic and robotic pyeloplasty rather than the open approach. Conclusion Laparoscopic pyeloplasty is safe and effective in infants and children, including redo and anatomically complex cases. Both transperitoneal and retroperitoneoscopic approaches yield excellent outcomes. Ultrasound is a reliable follow-up tool, potentially reducing reliance on radionuclide imaging.