title: Laparoscopic dismembered pyeloplasty--the method of choice in the presence of an enlarged renal pelvis and crossing vessels.
abstract: OBJECTIVE
  Herein we report our experience of 49 consecutive pyeloplasties that were all laparoscopically performed with an intracorporeally sutured anastomosis. We describe the operative technique, complications and outcomes during a follow-up period of 1-53 months (mean 23.2 months).
  
  
  METHODS
  Forty-nine patients (28 women and 21 men) with a mean age of 34 years (range 6-65 years) underwent a laparoscopic dismembered pyeloplasty because of primary ureteropelvic junction (UPJ) obstruction with hydronephrosis in each case. The preoperative evaluation included an evaluation for pain, an excretory urography (IVP), renal scan and sometimes CT angiography to evaluate for crossing vessels. Follow-up studies included an IVP, renal scan and renal ultrasound 4 weeks postoperatively and every 3 months thereafter. Success was considered as improvement of the pain score and IVP (less hydronephrosis, visible UPJ and/or normalization of drainage) or absence of an obstructive pattern during the washout phase of a renal scan.
  
  
  RESULTS
  There was no conversion to open surgery. The mean operative time was 165 min (range 90-240 min). Blood loss was negligible. Crossing vessels were noted in 57.1% of the patients (28/49). Postoperative hospital stay was 3.7 days (range 3-6 days). One patient had a leakage of the anastomosis on postoperative day 1 and needed to undergo laparoscopic repair. The mean follow-up is 23.2 months (range 1-53 months). There was one single late failure. This patient later underwent an open revision of the laparoscopic pyeloplasty. In all other patients (48/49), the obstruction was resolved or significantly improved. The long-term success rate is 97.7%.
  
  
  CONCLUSIONS
  The results of dismembered laparoscopic pyeloplasties compare favorably with those achieved by open pyeloplasties with less perioperative morbidity and discomfort. We do believe that laparoscopic dismembered pyeloplasty with an intracorporeal anastomosis is the method of choice in the treatment of the UPJ obstruction in the presence of an enlarged renal pelvis and crossing vessels.
authors.affiliation: Department of Urology, Charite Hospital School of the Humboldt University, Schumannstrasse 20-21, 10117, Berlin, Germany. harrytuerk@aol.com
authors.forename: Ingolf A
authors.initials: IA
authors.lastname: Türk
authors.forename: John W
authors.initials: JW
authors.lastname: Davis
authors.forename: Björn
authors.initials: B
authors.lastname: Winkelmann
authors.forename: Serdar
authors.initials: S
authors.lastname: Deger
authors.forename: Frank
authors.initials: F
authors.lastname: Richter
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fabrizio
authors.forename: Bernd
authors.initials: B
authors.lastname: Schönberger
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Jordan
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Loening
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000601:surgery*; D007668:Kidney / Q000098:blood supply / Q000601:surgery*; D007682:Kidney Pelvis; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*