title: Extraperitoneal laparoscopic dismembered fibrin-glued pyeloplasty: medium-term results.
abstract: OBJECTIVE
  To assess the feasibility and results of performing retroperitoneoscopic dismembered fibrin-glued pyeloplasty in a clinical series of patients with pelvi-ureteric junction (PUJ) obstruction.
  
  
  METHODS
  A balloon-dissecting four-port extraperitoneal laparoscopic approach was used in each of nine patients (aged 21-60 years) to dismember the PUJ over a previously placed double-pigtail stent, insert stay sutures to appose the urothelium and complete the pelvi-ureteric anastomosis using fibrin glue. Anastomoses were assessed by diuresis renography 3 months after surgery and at yearly intervals thereafter.
  
  
  RESULTS
  Eight of the nine attempted procedures were completed successfully in a median (range) operating time of 180 (150-230) min. The median (range) post-operative parenteral opiate requirement was 0 (0-80) mg morphine sulphate and the post-operative hospitalization was 2 (2-4) nights. A shortened fibrotic ureter prevented the laparoscopic completion of the second case, which was converted to an open procedure. Follow-up imaging after 1-2 years showed satisfactory upper tract drainage in those cases completed successfully. One patient developed a renal pelvic calculus that was treated by extracorporeal shock wave lithotripsy.
  
  
  CONCLUSIONS
  This technique is associated with a significantly shorter operating time than historical laparoscopic controls, and with a significantly lower post-operative opiate analgesic requirement and shorter post-operative hospitalization than in a contemporaneous series of patients undergoing open pyeloplasty. However, longer term follow-up is needed to fully assess the performance of these anastomoses.
authors.affiliation: Department of Urology, Kent & Canterbury Hospital, UK.
authors.forename: C G
authors.initials: CG
authors.lastname: Eden
authors.forename: S R
authors.initials: SR
authors.lastname: Sultana
authors.forename: K H
authors.initials: KH
authors.lastname: Murray
authors.forename: R K
authors.initials: RK
authors.lastname: Carruthers
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*
chemical_list: D015718:Fibrin Tissue Adhesive; D009294:Narcotics