[Use of microsurgery in the operative treatment of primary hydronephrosis]

Ureteropelvic junction obstruction is a congenital anomaly commonly afflicting the pediatric population, however, it is also more frequently than generally appreciated in the adult population. The method of postoperative urinary diversion - to divert by nephrostomy tube and/or splint or not to divert - was a matter of debate during the last twenty years. Through the application of microsurgery in pyeloplasty an external urinary diversion under commonly circumstances is not necessary. The Culp vertical flap pyeloplasty was modified by means of microsurgical instruments, ophthalmologic loupes (X 2, 6) and fine absorbable polyglactine sutures and used in 7 cases in 1984. The top of the flap is fixed in the distal ureteral incision by a U-shaped suture of 5-0 or 6-0 Vicryl followed by 2 continuous watertight sutures of the flap and the ureter and pyelon respectively. Only an extrarenal drainage for 4-8 days postoperatively was used. The mean duration of postoperative hospitalization was 10 days. The short-term radiographic, functional and clinical results after microsurgical pyeloplasty are excellent in 4 patients and good in 1 patient. The mean follow-up was only 4 months. Further experience, long-term follow-up and comparison with conventionally operated patients are necessary to evaluate the advantage of our microsurgical technique.