Laparoscopic pyeloplasty: current status.
OBJECTIVE
To review current publications and report our results and long-term follow-up of laparoscopic transperitoneal pyeloplasty for pelvi-ureteric junction (PUJ) obstruction.


METHODS
In all, 147 laparoscopic transperitoneal pyeloplasties were performed between August 1993 and November 2000 (mean patient age 35.7 years, range 10-85). All patients were diagnosed with PUJ obstruction by symptoms and intravenous urography, radionuclide diuretic renography or ultrasonography. An Anderson-Hynes dismembered pyeloplasty (106), Y-V plasty (28), Fenger plasty (11) and others (two) were used, according to the intraoperative findings. Twenty-five patients had secondary obstruction, having had previous surgery to the PUJ. The mean (range) follow-up was 24 (3-84) months; all patients were followed clinically and radiologically.


RESULTS
The mean operative duration time was 246 (100-480) min and estimated blood loss was 158 mL. Crossing vessels were identified in 80 cases. The success rate for all, primary and secondary patients was 95%, 98% and 84%, respectively. With one exception, all failures occurred within 6 months. Twenty-one patients (22 renal units) had simultaneous laparoscopic pyeloplasty and lithotomy; they were treated successfully and all have an intact PUJ, and 20 renal units (90%) were stone-free. The overall complication rate was 8.8%.


CONCLUSIONS
This series has comparable success rates to those of open pyeloplasty and the morbidity was minimal. Laparoscopic pyeloplasty may soon become the standard operation for PUJ obstruction, especially with crossing vessels.
Inagaki
Takeshi
T
The Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. twy@jhmi.edu
Rha
Koon H
KH
Ong
Albert M
AM
Kavoussi
Louis R
LR
Jarrett
Thomas W
TW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*