title: Creation of ureteropelvic junction obstruction and its correction by chemical glue-assisted laparoscopic dismembered pyeloplasty.
abstract: OBJECTIVE
  We established a porcine model of ureteropelvic junction (UPJ) obstruction using a laparoscopic technique and assessed the outcome of standard suture-assisted and chemical glue-assisted laparoscopic pyeloplasty.
  
  
  METHODS
  Female domestic pigs (N = 20) underwent laparoscopic suture-ligature to create UPJ obstruction. One month later, laparoscopic end-to-end anastomosis was performed to correct the obstruction: with standard suturing techniques in 10 animals and with chemical (cyanoacrylate) glue in the other 10. Postoperative ureteral stents were not used. Four weeks postoperatively, intravenous urography was performed to evaluate the patency of the anastomoses. The UPJ was procured by laparotomy to assess the anastomoses and periureteral fibrosis histologically.
  
  
  RESULTS
  The UPJ obstruction was created in an average of 15 +/- 6 minutes. There was no early postoperative mortality. Eighteen pigs survived for at least 1 month, and UPJ obstruction developed in 17 (95%). Microscopically, the lumen of the UPJ was partially occluded, measuring an average of 40% +/- 5% of normal. After laparoscopic correction, a patent UPJ was found in seven of nine animals treated with traditional sutures. Among the eight animals with chemically glued anastomoses, none had a patent UPJ, and severe periureteral adhesions and intraluminal fibrosis were noted at the pyeloplasty site. Marked ureteral tortuosity was present in six of the eight pigs receiving glue-assisted pyeloplasty but in none of the animals having suture-assisted pyeloplasty.
  
  
  CONCLUSIONS
  Ureteropelvic junction obstruction was established by laparoscopic suture-ligature in a porcine model with a 95% success rate. Chemical glue-assisted anastomosis was inferior to standard laparoscopic sutures for pyeloplasty to correct the obstruction.
authors.affiliation: Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Chiu
authors.forename: Chia-Hsing
authors.initials: CH
authors.lastname: Lin
authors.forename: Steve K
authors.initials: SK
authors.lastname: Huan
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Liu
authors.forename: Chih-Chan
authors.initials: CC
authors.lastname: Lin
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Huang
authors.forename: Win-Long
authors.initials: WL
authors.lastname: Lin
authors.forename: Sheng-Hsien
authors.initials: SH
authors.lastname: Huang
authors.forename: Po-Shing
authors.initials: PS
authors.lastname: Lee
authors.forename: Ching-Nan
authors.initials: CN
authors.lastname: Lin
mesh_terms: D000269:Adhesives; D000818:Animals; D003487:Cyanoacrylates; D004195:Disease Models, Animal; D005260:Female; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation; D013537:Sutures; D013552:Swine; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D000269:Adhesives; D003487:Cyanoacrylates