Laparoscopic Fenger plasty

At our department, adults presenting with hydronephrosis secondary to short intrinsic stenoses of the ureteropelvic junction (UPJ) or ventrally crossing vessels are treated with laparoscopic nondismembered pyeloplasty. We herein present our long-term results.

From August 1994 to September 1999, 34 female and 31 male patients presenting with 67 obstructed UPJs underwent laparoscopic nondismembered pyeloplasty. The patients' ages ranged from 11 to 77 (mean 35.6) years. Preoperatively, all patients were evaluated with intravenous urography and isotope scans. In addition, color Doppler ultrasonography was performed to identify crossing vessels at the UPJ. Prior to surgery, a stent was placed, which was left indwelling until 6 weeks after surgery. On the right side, the transperitoneal and on the left, the retroperitoneal approach was used. Following dissection of the UPJ, the obstructing vessels were displaced. The stenosis of the UPJ was corrected by either Fenger plasty (63 UPJs) or Y-V plasty (4 UPJs). Postoperative evaluation included color Doppler ultrasonography, intravenous urography, and isotope studies.

The mean operative time was 123 minutes. No intraoperative complications were seen. In 79% of the patients, ventrally crossing vessels were found and displaced from the UPJ. Forty-eight patients have been available for follow-up, which currently ranges from 4 to 60 (mean 25) months. In the most recent nine patients, the position of the crossing vessels relative to the UPJ was also assessed postoperatively by means of color Dopper ultrasonography. The mean distance of the vessels from the UPJ was 1.5 cm. There was a single failure, in a 19-year-old woman who presented with infected hydronephrosis. Laparoscopic nondismembered pyeloplasty failed because the stenosis, which was aggravated by the infection, was too long. The success rate thus was 98%.

At our department, laparoscopic nondismembered pyeloplasty is the preferred method for the management of UPJ obstruction, while dismembered pyeloplasty is performed in rare cases only.