title: Laparoscopic pyeloplasty for ureteropelvic junction obstruction: outcome of initial 12 procedures.
abstract: BACKGROUND
  Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25 months (range, 12-42 months).
  
  
  METHODS
  Between March 1999 and September 2001 we performed laparoscopic pyeloplasty on 12 ureters in 11 patients presenting with symptomatic hydronephrosis, secondary to a short stenosis of the UPJ or to ventrally crossing vessels; bilateral pyeloplasty was performed as a single procedure in one patient. We performed dismembered Anderson-Hynes pyeloplasty, Fenger plasty and Y-V plasty in eight, two and two ureters, respectively. All procedures were carried out transperitoneally.
  
  
  RESULTS
  The procedure was completed successfully in all cases. Crossing vessels were noted in six of 12 ureters (50.0%). Mean operative time and blood loss in 11 patients (including one bilateral case) were 272.8 min (range, 175-480 min) and 96.4 mL (range, 20-340 mL), respectively. Postoperative complications were noted in two patients (18.2%): one instance of prolonged urine leakage and one anastomotic re-stricture. Eleven of 12 ureters (91.6%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 12 months.
  
  
  CONCLUSIONS
  Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. Laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for UPJ obstruction.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. miwamura@med.kitasato-u.ac.jp
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Soh
authors.forename: Akira
authors.initials: A
authors.lastname: Irie
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kadowaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsusita
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fujioka
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*