title: Laparoscopic dismembered tubularized flap pyeloplasty: a novel technique.
abstract: OBJECTIVE
  Laparoscopic dismembered pyeloplasty is now an effective option for ureteropelvic junction obstruction. We describe a novel laparoscopic technique of dismembered tubularized flap pyeloplasty for a difficult recurrent long ureteropelvic junction stricture.
  
  
  METHODS
  A 73-year-old woman with ureteropelvic junction obstruction of a solitary left kidney had undergone failed multiple procedures, including open pyeloplasty, balloon incision endopyelotomy, retrograde balloon dilation and percutaneous endopyelotomy. Using a 4-port transperitoneal laparoscopic technique, the upper ureter was dissected, the scarred ureteropelvic junction stricture was excised and the dismembered ureteropelvic junction was closed with a stitch. A wide base renal pelvic flap was created and tubularized to bridge the 3 cm. upper ureteral defect. Laparoscopic intracorporeal freehand suturing was done to reconstruct the renal pelvis and upper ureter over a Double-J stent (Medical Engineering Corp., New York, New York).
  
  
  RESULTS
  Total operative time was 4.5 hours and hospital stay was 4 days. The stent was removed 3 weeks later. At the 2-month followup the patient was asymptomatic. Excretory urography and diuretic renal scan confirmed a widely patent upper ureter with unobstructed drainage.
  
  
  CONCLUSIONS
  Dismembered renal pelvis tubularized flap pyeloplasty can be successfully performed laparoscopically to bridge a long upper ureteral defect. This approach is feasible even in a ureteropelvic junction in which previous surgery has failed.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, A-100, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Wayne
authors.initials: W
authors.lastname: Kuang
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D013524:Surgical Flaps; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery