Laparoscopic dismembered tubularized flap pyeloplasty: a novel technique.
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.
Kaouk
Jihad H
JH
Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, A-100, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
Kuang
Wayne
W
Gill
Inderbir S
IS
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