[Laparoscopic and retroperitoneoscopic kidney pyeloplasty].

The aim of this study was to evaluate laparoscopic and retroperitoneoscopic pyeloplasty and to compare the efficacy of dismembered and non-dismembered techniques. Between April 1993 and December 1995 a modified laparoscopic transperitoneal (18 patients) and a retroperitoneoscopic approach (3 patients) were used for the management of ureteropelvic junction obstruction. In 11 patients aberrant vessels were encountered; one patient had a horse-shoe kidney. Surgical repair was achieved by dismembered pyeloplasty (8 patients), non-dismembered Fenger-plasty (longitudinal incision-transverse closure: 7 patients), transection and reanastomosis of the renal pelvis (1 patient), ureterolysis and displacement of ventrally crossing vessels (4 patients). In one patient dismembered pyeloplasty could not be scheduled because of cardiovascular problems. A minimal transient lesion of the sympathetic nerve was observed postoperatively in one patient and pulmonary embolism in another. The operative time in dismembered pyeloplasty was between 240 and 360 min (mean 280); the results were good in all patients. Equally good results were obtained with non-dismembered Fenger-plasty, and the operating time was shorter (120-180 min). Ureterolysis was found to have a failure rate of 50%. Laparoscopic dismembered pyeloplasty yielded good results, but it is too complicated to become a standard procedure. Non-dismembered Fenger-plasty, which also showed good results, is more suitable for laparoscopy and retroperitoneoscopy. The indications for this technique should be defined more precisely as more experience is collected. The results of ureterolysis-when used as a single measure-were poor, and therefore this technique should be abandoned.