Laparoscopic pyeloplasty for ureteropelvic junction obstruction

PURPOSE: We performed laparoscopic pyeloplasty in 11 patients with ureteropelvic junction (UPJ) obstruction and evaluated the clinical outcomes of this surgery. MATERIALS AND METHODS: Between August 2001 and February 2004, 11 patients with UPJ obstruction underwent laparoscopic pyeloplasty in our institute. In all patients, symptoms were presented and UPJ obstruction was confirmed by radiographic examinations. Ten patients had primary obstruction, while one patient had secondary obstruction. Retroperitoneal approach was applied in all but one patient who needed intraperitoneal approach due to secondary obstruction. We performed Anderson-Hynes dismembered pyeloplasty, Hellstrom technique and Fenger plasty in 8, 2 and 1 patient, respectively. Nephropexy was performed in 2 patients with nephroptosis, and isthmusectomy was performed in 1 patient with horseshoe kidney, simultaneously. RESULTS: The mean operative time was 312 minutes (210-371) and the mean blood loss (including urine) was 75 ml. No blood transfusion was required, and all procedures were performed safely. Crossing vessels were found in 5 patients (45%). Pyelonephritis was the only postoperative complication, managed by the administration of antibiotics. Symptoms were disappeared without recurrences in all patients at mean follow up time of 18 months (6-36). ( CONCLUSION: Although the number of cases was small with relatively short follow up period, the clinical outcomes of laparoscopic pyeloplasty in our institute were almost satisfied, as previously reported by other investigators. Laparoscopic pyeloplasty might be one of the standard treatments for patients with UPJ obstruction, although we should carefully consider about indication, approach and operation method.