title: Retroperitoneoscopic pyeloplasty with concomitant neophropexy for a ureteropelvic junction obstruction in combination with nephroptosis.
abstract: OBJECTIVE
  We herein describe our technique for retroperitoneoscopic pyeloplasty with concomitant nephropexy in patients with a ureteropelvic junction (UPJ) obstruction in combination with nephroptosis.
  
  
  METHODS
  We performed this operation on three female patients with a right UPJ obstruction and nephroptosis diagnosed by intravenous urography, retrograde pyelography, computed tomography and an isotopic renogram. All patients underwent the insertion of a ureteral stent before laparoscopy, and they were placed in the flank position. A four-port, balloon-dissecting, retroperitoneal laparoscopic approach was used. Gerota's fascia was incised and the perirenal fat was completely dissected from the kidney. A UPJ obstruction was identified and pyeloplasty was performed using Anderson-Hynes dismembered anastomosis. Next, kidney fixation to the abdominal wall was performed by rows of renal capsular 2-0 nylon sutures which were secured to the quadratus lumborum fascia. All procedures were performed retroperitoneoscopically.
  
  
  RESULTS
  The median operative time was 350 min with a range from 204 to 414 min. The median estimated blood loss was 50 ml with a range from 10 to 200 ml. The postoperative hospital stay was 6 days. There were no postoperative complications. The ureteral stent was removed at 6 weeks after surgery. Postoperative urography revealed a complete resolution of hydronephrosis in all cases with one complete resolution and two cases with an improvement of nephroptosis. All patients had a complete resolution of their symptoms.
  
  
  CONCLUSIONS
  Retroperitoneoscopic pyeloplasty with concomitant nephropexy seems to be a feasible, effective and minimally invasive procedure for treating UPJ obstruction in combination with nephroptosis.
authors.affiliation: Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. kazushi@med.kobe-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Nakano
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: G
authors.initials: G
authors.lastname: Kawabata
authors.forename: I
authors.initials: I
authors.lastname: Hara
authors.forename: A
authors.initials: A
authors.lastname: Takenaka
authors.forename: M
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D011183:Postoperative Complications / Q000209:etiology; D011391:Prolapse; D013536:Suture Techniques; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult