title: Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study.
abstract: BACKGROUND
  Laparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy.
  
  
  METHODS
  Six patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology.
  
  
  RESULTS
  All patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy.
authors: Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
authors: Omar
authors: O
authors: Fahmy
authors: Zagazig University, Department of Urology, Zagazig, Egypt.
authors: Abdel-Rahman
authors: AR
authors: El-Fayoumi
authors: Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
authors: Georgios
authors: G
authors: Gakis
authors: Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
authors: Bastian
authors: B
authors: Amend
authors: University Putra Malaysia, Department of Urology, Selangor, Malaysia.
authors: Mohd Ghani
authors: MG
authors: Khairul-Asri
authors: Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
authors: Arnulf
authors: A
authors: Stenzl
authors: Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
authors: Christian
authors: C
authors: Schwentner
keywords: difficult pyeloplasty; laparoscopic pyeloplasty; ureteropelvic junction obstruction