Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO): solving the technical difficulties.
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.
Bachmann
A
A
Department of Urology, University Hospital Basel, Basel, Switzerland. bachmann@uhbs.ch
Ruszat
R
R
Forster
T
T
Eberli
D
D
Zimmermann
M
M
Müller
A
A
Gasser
T C
TC
Sulser
T
T
Wyler
S
S
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*