Laparoscopic surgery for upper urinary tract pathologies: a retrospective single-center experience

Laparoscopic surgery has transformed the management of upper urinary tract pathologies globally. However, data from low- and middle-income countries (LMICs), particularly the Middle East, remain limited. This study presents a comprehensive evaluation of laparoscopic urological procedures performed at a high-volume tertiary center in Jordan. A retrospective cohort study was conducted at King Abdullah University Hospital (KAUH), including 270 patients who underwent laparoscopic procedures for upper urinary tract conditions. Data on demographics, operative characteristics, perioperative outcomes, complications, and histopathological findings were extracted from electronic medical records. Subgroup analyses were performed comparing oncological versus non-oncological procedures and obese versus non-obese patients. The mean patient age was 45.7 ± 19.4 years, with 55.9% males. The most prevalent comorbidities were hypertension (38.9%) and diabetes mellitus (19.0%). Radical nephrectomy (32.2%) and simple nephrectomy (23.7%)were the most frequently performed procedures. The median operative time was 120 min, with a mean estimated blood loss of 115.8 mL. The overall conversion rate to open surgery was 5.2%, and the complication rate was 4.4%. The median length of hospital stay was 2 days. Intraoperative and postoperative blood transfusion rates were 0.7% and 3.3%, respectively (10 of the 270 patients, 3.7%, required transfusion). Malignant pathology was identified 45.2% of the 250 histopathological specimens examined, with clear cell renal cell carcinoma being the most common subtype (60.2% of malignancies). Oncological procedures were associated with significantly greater estimated blood loss and longer hospitalization compared to non-oncological procedures ( P < 0.001). Obese patients (BMI ≥ 30) had a significantly higher complication rate than non-obese patients (8.6% vs. 2.5%, P = 0.033). Laparoscopic surgery for upper urinary tract pathologies appears to be a safe and effective approach in a Jordanian tertiary center. Despite resource constraints inherent to LMIC settings, perioperative outcomes were broadly consistent with international benchmarks, supporting the continued expansion of laparoscopic urological programs in the region.