title: Renal pelvis flap--guide for ureteral spatulation and handling during dismembered pyeloplasty.
abstract: BACKGROUND
  To present a technical modification of the classic dismembered pyeloplasty technique. We have implemented it in 112 pyeloplasties performed during the past 15 years.
  
  
  METHODS
  The technical modification is based on a renal pelvis flap kept undetached from the ureteropelvic junction, and consequently from the ureter, until near completion of the new ureteropelvic anastomosis. This flap is used for ureteral handling (a "no touch" technique) during pyeloplasty and also serves as a very reliable guide for lateral ureteral spatulation, preventing ureteral twisting and subsequent misalignment of the de novo ureteropelvic junction. We experienced early complications in 4 patients (3.6%). Two patients had excessive urinary leakage from the ureteropelvic anastomosis because of misplacement of a Nelaton retroperitoneal tube drain. We have used soft Penrose drains for retroperitoneal drainage since. Two other patients needed reoperation because of a redundant renal pelvis and ureter consequent to a remnant high anastomosis and insertion of the ureter to the renal pelvis with subsequent kinking and obstruction. No other early or late complications attributable to obstruction of the anastomosis resulting from devascularization or misalignment between the ureter and renal pelvis were encountered.
  
  
  CONCLUSIONS
  Modification of the classic pyeloplasty technique has proved relatively easy and reliable in our experience. With the increasing popularity of the laparoscopic approach for pyeloplasty, the described technical modification may become useful for laparoscopic handling of the ureter.
authors.affiliation: Department of Urology, Soroka University Medical Center, Ben Gurion University Faculty of Health Sciences, Beer Sheva, Israel. endre@bgu.ac.il
authors.forename: Endre Z
authors.initials: EZ
authors.lastname: Neulander
authors.forename: Igor
authors.initials: I
authors.lastname: Romanowsky
authors.forename: Murad
authors.initials: M
authors.lastname: Assali
authors.forename: Joseph
authors.initials: J
authors.lastname: Klain
authors.forename: Leonard
authors.initials: L
authors.lastname: Lissmer
authors.forename: Jacob
authors.initials: J
authors.lastname: Kaneti
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000517:prevention & control; D013520:Urologic Surgical Procedures / Q000379:methods*