RETROPERITONEOSCOPIC DISMEMBERED FIBRIN-GLUED PYELOPLASTY - INITIAL REPORT

Dismembered pyeloplasty offers the best long-term results for the trea tment of pelviuretic junction (PUJ) obstruction and is the only techni que applicable to all cases, regardless of aetiology. The disadvantage s of open pyeloplasty (wound pain, prolonged hospitalization and a del ayed return to normal activities) can largely be overcome by the adopt ion of a laparoscopic approach. The trauma of access may be further re duced by direct retroperitoneal endoscopy, and long-term anastomotic p atency enhanced by the use of fibrin glue, based on the results of a r ecent comparative study of tissue approximation techniques by the firs t author. Retroperitoneoscopic dismembered fibrin-glued pyeloplasty wa s performed in a female with PUJ obstruction, previously complicated b y pyonephrosis, in an operating time of 230 min. Drainage and post-ope rative opiate analgesic requirements were minimal and the patient was discharged home on the fourth post-operative day. Diuresis renography at 3 months (6 weeks following stent removal) revealed a normal draini ng upper renal tract. Long-term renographic follow-up is necessary to fully evaluate this technique.