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

comparison of augmentation cystoplasty before and after renal transplantation with the control group

We compared two surgical methods of augmentation cystoplasty [AC], before and after renal transplantation, and the outcomes of both methods with transplant patients with normal bladder function. 1520 kidney transplantations were performed at Shahid Labbafinejad Center between March 1988 and February 2002 of which 36 cases was accompanied with AC. In 20 patients [group A] AC was performed before transplantation. This group consisted of 14 males and 6 females with a mean age of 26.1 [13-39] at the time of transplantation. Sixteen patients consisting of 11 males and 5 females [mean age 27.3, 12-44] underwent AC after transplantation. Eventually 40 transplant patients with normal bladder function were assigned in the control group including 18 males and 22 females with a mean age of 31.2 [11-55] [group C]. Normal graft function was achieved in 16, 13, and 33 patients of groups A, B, and C respectively over the mean follow-up of 70, 59, and 76 months [p<0.7]. Mean serum creatinine during the follow-up was 1.48 +/- 0.4, 1.7 +/- 1, and 1.4 +/- 0.55 for groups A, B, and C respectively. 9, 12, and 17 patients [26, 64, and 34 cases] with UTI requiring hospital admission were observed in the 3 groups respectively. The incident of UTI and the resultant hospitalization in group B was more than the one in group C [p<0.03], but it did not differ significantly from group A to group C. AC is a safe and effective method to improve the lower urinary system function and with the exception of increased risk of UTI following AC after transplantation [group B], there is no considerable difference in the complication rates between AC before and after renal transplantation. As a result, we can perform AC before or after kidney transplantation in patients with dysfunctional lower urinary tract system up to their specific conditions