title: Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO): solving the technical difficulties.
abstract: OBJECTIVE
  To evaluate our current practice in retroperitoneoscopic pyeloplasty in patients with ureteropelvic junction obstruction (UPJO). Special interest was paid to technical difficulties associated with the retroperitoneoscopic approach.
  
  
  METHODS
  Our retroperitoneoscopic approach for pyeloplasty is explained step for step including the most technically challenging part: the ureteropelvic anastomosis.
  
  
  RESULTS
  Within 49 months a total of 47 retroperitoneoscopic pyeloplasties we performed at our institution. Before pyeloplasty an endopyelotomy had failed in five patients (11%). We did not necessarily perform a ventral transposition of the anastomosis in cases with a crossing vessel. Two (4%) conversions to open surgery were required because of scarring after previous endopyelotomy and massive obesity resulting in a limited working space. There were no intraoperative complications. A recurrence of UPJO was observed in 2% (n = 1).
  
  
  CONCLUSIONS
  Functional results after retroperitoneoscopic pyeloplasty are excellent and comparable to those of open surgery. However, special knowledge of retroperitoneoscopy is necessary to provide the patient with a safe and effective minimally invasive alternative to open pyeloplasty.
authors.affiliation: Department of Urology, University Hospital Basel, Basel, Switzerland. bachmann@uhbs.ch
authors.forename: A
authors.initials: A
authors.lastname: Bachmann
authors.forename: R
authors.initials: R
authors.lastname: Ruszat
authors.forename: T
authors.initials: T
authors.lastname: Forster
authors.forename: D
authors.initials: D
authors.lastname: Eberli
authors.forename: M
authors.initials: M
authors.lastname: Zimmermann
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.forename: T C
authors.initials: TC
authors.lastname: Gasser
authors.forename: T
authors.initials: T
authors.lastname: Sulser
authors.forename: S
authors.initials: S
authors.lastname: Wyler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*