Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction

The aim of this study was to evaluate laparoscopic and retroperitoneoscopic pyeloplasty and to compare the efficacy of dismembered and nondismembered techniques.

Since May 1993, a modified laparoscopic transperitoneal (14 patients) and a retroperitoneoscopic approach (3 patients) have been used for the management of ureteropelvic junction obstruction. In 7 patients aberrant vessels were encountered; 1 patient had a horseshoe kidney. Surgical repair was achieved by dismembered pyeloplasty (8 patients), nondismembered Fenger-plasty (longitudinal incision, transverse closure; 3 patients), transaction and reanastomosis of the renal pelvis (1 patient), ureterolysis and displacement of crossing vessels (4 patients).

In 1 patient dismembered pyeloplasty could not be scheduled because of cardiovascular problems. A minimal transient lesion of the sympathetic nerve was observed postoperatively in 1 patient and pulmonary embolism in another. The operative time in dismembered pyeloplasty was between 240 and 360 minutes (mean, 280); the results were good in all patients. Equally good results were obtained with nondismembered Fenger-plasty, and the operating time was shorter (120 to 180 minutes). Ureterolysis was found to have a failure rate of 50%.

Laparoscopic dismembered pyeloplasty yielded good results but it is too complicated to become a standard procedure. Nondismembered Fenger-plasty, which also showed good results, is more suitable for laparoscopy and retroperitoneoscopy. The indications for this technique should be defined more precisely as more experience is being collected. The results of ureterolysis when used as a single measure were poor, and, therefore, this technique should be abandoned.