title: Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty.
abstract: OBJECTIVE
  First line treatment of ureteropelvic junction obstruction is still open dismembered pyeloplasty. The development of videoendoscopic techniques like endopyelotomy and laparoscopy offers less invasive alternatives. The long-term outcome of an algorithm selectively using these techniques is presented.
  
  
  METHODS
  From February 1995 to March 2006, 256 patients with ureteropelvic junction obstruction were treated with 113 laser endopyelotomies and 143 laparoscopic retroperitoneal pyeloplasties. According to changing selection criteria, an early group (92 in 1995 to 1999) treated with laser endopyelotomy for extrinsic as well as intrinsic stenoses, and a late group (164 in 2000 to 2006) treated with laser endopyelotomy for intrinsic stenosis, were evaluated. In the late group extrinsic ureteropelvic junction obstruction was treated with nondismembered pyeloplasty in cases of anteriorly and by dismembered pyeloplasty in cases of posteriorly crossing vessels or a redundant renal pelvis.
  
  
  RESULTS
  Operating time of laser endopyelotomy averaged 34 (range 10 to 90) minutes with a complication rate of 5.3% and a success rate of 72.6% (intrinsic 85.7% vs extrinsic 51.4%). Operating time of laparoscopic retroperitoneal pyeloplasty averaged 124 (range 37 to 368) minutes with a 6.3% complication rate and an overall success rate of 94.4% (intrinsic 100% vs extrinsic 93.8%). In the late group the LAP success rate was 98.3% with no significant differences related to the cause of ureteropelvic junction obstruction (intrinsic 100% vs extrinsic 98.1%) or the type of pyeloplasty (YV plasty 97.0% vs Anderson-Hynes 97.7%).
  
  
  CONCLUSIONS
  Laparoscopic retroperitoneal pyeloplasty yields an efficacy similar to that of open surgery. The inferior success of laser endopyelotomy even in optimally selected cases and the increasing expertise with endoscopic suturing may favor laparoscopic pyeloplasty with or without robotic assistance in the future.
authors.affiliation: Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany. jens.rassweiler@slk-kliniken.de
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Rassweiler
authors.forename: Svetozar
authors.initials: S
authors.lastname: Subotic
authors.forename: Michaela
authors.initials: M
authors.lastname: Feist-Schwenk
authors.forename: Marto
authors.initials: M
authors.lastname: Sugiono
authors.forename: Michael
authors.initials: M
authors.lastname: Schulze
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Thomas
authors.initials: T
authors.lastname: Frede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis; D010535:Laparoscopy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012187:Retroperitoneal Space; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*