OBJECTIVE: To report on our experience with laparoscopic retroperitoneal dismembered pyeloplasty in the treatment of ureteropelvic junction (UPJ) obstruction. Special attention was paid to the technical features associated with the procedure. SUBJECTS AND METHODS: From May 2004 to April 2012, in total, 117 consecutive patients (64 men and 53 women) with a mean age of 33.5 years (range, 12-60 years) underwent laparoscopic retroperitoneal dismembered pyeloplasty for symptomatic and radiologically proved UPJ obstruction. Follow-up studies were performed with diuretic renography at 3 and 6 months postoperatively and annually thereafter. Success was defined as symptomatic relief and improvement of the diuresis renogram without evidence of obstructed drainage. RESULTS: The mean operative time was 170 minutes (range, 90-310 minutes), and the mean estimated blood loss was 40 mL (range, 20-100 mL). Crossing vessels were encountered in 21 patients (18.0%). In all cases, the ureter was transposed anteriorly. From 9 patients, including 4 cases of horseshoe kidney, coexisting renal calculi were successfully removed. The mean hospital stay was 7 days (range, 5-14 days). There were no intraoperative complications. Postoperative complication was recorded in 2 patients with leakage at the anastomosis. Seven patients developed anastomotic strictures, which required open surgery or ureteral stent. The success rate was 94% (110/117) at a mean follow-up of 43 months (range, 3-95 months). CONCLUSIONS: In our experience, laparoscopic retroperitoneal dismembered pyeloplasty is effective and feasible. With the improvement of technique, we believe that it would become a new standard treatment for UPJ obstruction.
OBJECTIVE: To report on our experience with laparoscopic retroperitoneal dismembered pyeloplasty in the treatment of ureteropelvic junction (UPJ) obstruction. Special attention was paid to the technical features associated with the procedure. SUBJECTS AND METHODS: From May 2004 to April 2012, in total, 117 consecutive patients (64 men and 53 women) with a mean age of 33.5 years (range, 12-60 years) underwent laparoscopic retroperitoneal dismembered pyeloplasty for symptomatic and radiologically proved UPJ obstruction. Follow-up studies were performed with diuretic renography at 3 and 6 months postoperatively and annually thereafter. Success was defined as symptomatic relief and improvement of the diuresis renogram without evidence of obstructed drainage. RESULTS: The mean operative time was 170 minutes (range, 90-310 minutes), and the mean estimated blood loss was 40 mL (range, 20-100 mL). Crossing vessels were encountered in 21 patients (18.0%). In all cases, the ureter was transposed anteriorly. From 9 patients, including 4 cases of horseshoe kidney, coexisting renal calculi were successfully removed. The mean hospital stay was 7 days (range, 5-14 days). There were no intraoperative complications. Postoperative complication was recorded in 2 patients with leakage at the anastomosis. Seven patients developed anastomotic strictures, which required open surgery or ureteral stent. The success rate was 94% (110/117) at a mean follow-up of 43 months (range, 3-95 months). CONCLUSIONS: In our experience, laparoscopic retroperitoneal dismembered pyeloplasty is effective and feasible. With the improvement of technique, we believe that it would become a new standard treatment for UPJ obstruction.
Authors: Mohamed M Gargouri; Yassine Nouira; Yousri Kallel; Ahmed Sellami; Rami Boulma; Chlif Mohamed; Sami Ben Rhouma Journal: Arab J Urol Date: 2013-09-29