LAPAROSCOPIC AND RETROPERITONEOSCOPIC REPAIR OF URETEROPELVIC JUNCTION OBSTRUCTION

Objectives. The aim of this study was to evaluate laparoscopic and ret roperitoneoscopic pyeloplasty and to compare the efficacy of dismember ed and nondismembered techniques. Methods. Since May 1993, a modified laparoscopic transperitoneal (14 patients) and a retroperitoneoscopic approach (3 patients) have been used for the management of ureteropelv ic junction obstruction. In 7 patients aberrant vessels were encounter ed; 1 patient had a horseshoe kidney. Surgical repair was achieved by dis membered pyeloplasty (8 patients), nondismembered Fenger-plasty (l ongitudinal incision, transverse closure; 3 patients), transection and reanastomosis of the renal pelvis (1 patient), ureterolysis and displ acement of crossing vessels (4 patients). Results. In 1 patient dismem bered pyeloplasty could not be scheduled because of cardiovascular pro blems. A minimal transient lesion of the sympathetic nerve was observe d postoperatively in patient and pulmonary embolism in another. The op erative time in dismembered pyeloplasty was between 240 and 360 minute s (mean, 280); the results were good in all patients. Equally good res ults were obtained with nondismembered Fenger-plasty, and the operatin g time was shorter (120 to 180 minutes). Ureterolysis was found to hav e a failure rate of 50%. Conclusions. Laparoscopic dismembered pyelopl asty yielded good results, but it is too complicated to become a stand ard procedure. Nondismembered Fenger-plasty, which also showed good re sults, is more suitable for laparoscopy and retroperitoneoscopy. The i ndications 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 b e abandoned.