Laparoscopic ureteropelvic junction decompression for the management of obstruction

We reported the outcome and complications of laparoscopic aberrant vessels transposition without performing pyeloplasty in patients with ureteropelvic stenosis. A total of 10 patients with ureteropelvic stenosis accompanying with aberrant vessels underwent laparoscopic transposition of vessels between June 2001 and March 2003. 4 of the cases were male and 6 were female, and 4 out of 10 had right side and 6 had left side involvement. The mean age was 31.9 [14-59]. Reaction of aberrant vessels was performed by cutting the vain and fixing the artery to the lipid layer around the kidney and renal pelvis. The procedure was successful in all the cases without any perioperative complications. The operative time was 2.20 hours [1.45-2.50] including cystoscopy, DJ placement, and transposition. Mean hospital stay was 2.9 [2-5] days, and patients were followed up an average of 9.1 [3-22] months. Except one case of rehospitalization due to pain, no complication occurred. The rate of clinical and radiological improvement was 100% and IVP showed a decrease in the degree of hydronephrosis as well as the resolution of obstruction observed in renogram. With regard to our findings, it seems, at least in a proportion of patients with UPJ stenosis accompanied with crossing vessels, that mechanical compression is the mere cause of obstruction and primary stenosis does not coexist. As a result, treatment is achieved by transposition of the crossing vessels without entering the renal unit

Endourology: a comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction

To compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction [UPJO] were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar [6.2 days] in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons