title: Retroperitoneoscopic pyeloplasty: using reconstructive methods based on intraoperative findings.
abstract: OBJECTIVE
  Reconstructive laparoscopic procedures have been recognized as a less invasive treatment than conventional open procedures. However, although the laparoscopic pyeloplasty has also been accepted as useful, few findings have been reported relevant to the retroperitoneal approach. To elucidate its effectiveness and safety, laparoscopic surgery via the retroperitoneal approach was examined in our institution. Furthermore, the importance of laparoscopic observation for ureteropelvic junction and urine passage ureteropelvic junction without indwelling ureteral stent.
  
  
  METHODS
  Between July 1998 and December 2004, 13 men and 15 women underwent laparoscopic retroperitoneal surgery for ureteropelvic junction obstruction. The mean patient age was 33.6 years (range: 13-70 years). Methods of repair were determined by intraoperative findings for the relationship between the ureteropelvic junction and surrounding vessels. An indwelling ureteral stent was removed before initiating laparoscopic operation to observe the relationship between ureteropelvic junction and aberrant vessels more precisely.
  
  
  RESULTS
  An aberrant renal vessel was found in 13 patients (46%). Dismembered pyeloplasty was carried out in 21 patients, Y-V plasty in five patients and Hellstrom technique in two patients. Ureteral transposition was not required in dismembered pyeloplasty cases. All patients achieved retroperitoneoscopic pyeloplasty without open conversion. The mean operative time was 272 min (range: 155-490 min). The mean estimated blood loss was 44 mL (range: 10-200 mL). No major complications were observed during the intraoperative period, but urinary tract infection occurred in two patients in the postoperative period. In all patients except one, obstruction was improved or resolved.
  
  
  CONCLUSIONS
  Laparoscopic retroperitoneal surgery is not only able to repair ureteropelvic junction obstruction, but can also be done safety and less invasively. We believe that laparoscopic observation without indwelling stent will contribute to a more appropriate choice of pyeloplasty.
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Moriguchi city, Osaka, Japan. kawag@takii.kmu.ac.jp
authors.forename: Gen
authors.initials: G
authors.lastname: Kawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tatsumi
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Hiura
authors.forename: Koei
authors.initials: K
authors.lastname: Muguruma
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000601:surgery*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures