Ces Urol 2003, 7(4):6-10 | DOI: 10.48095/cccu2003021

Laparoscopic and retroperitoneoscopic pyeloplasty

R. Kočvara^1,2, J. Sedláček¹, M.Vraný³, J. Dvořáček^1,2, Z. Dítě^1,2

¹ Urologická klinika VFN a 1. LF UK, Praha, vedoucí J. Dvořáček

² Subkatedra dětské urologie a katedra urologie IPVZ Praha, vedoucí R. Kočvara a J. Dvořáček

³ Chirurgické oddělení Nemocnice Jablonec nad Nisou, vedoucí M. Vraný

Aim of the study. To compare the treatment of stenosis of pyeloureteral junction (PUJ) by laparoscopic technique with open surgery and to draw attention to the problems associated with the implementation of this technique.

Patients and methods: We indicated 12 patients to laparoscopic (LP) or retroperitoneoscopic (RP) pyeloplasty because of stenosis of PUJ from March 2001 do May 2003. Except for one female patient (58 years), all patients were 12,5 to 19,3 years (mean 16,4 years) of age. We compared them to a group of 13 patients in the age of 9 to 26 years (mean 13,4 years), operated on by transmuscular lumbotomic incission in the years 2000-2001.

Results: LP surgery was performed in 7, RP in 5 patients, of which one was converted to open surgery and one finished by laparoscopy because of opening of the peritoneum. In 8 of 12 patients a bundle of abberant vessels was found over PUJ. In one female patient an obstructed ureteral stent had to be replaced after surgery. In comparison with open surgery, there is less need of analgesics (67 vs. 105 mg of piritramide) and a shorter postsurgical recovery, but the duration of the procedure is twice as long (150 vs. 310 minutes). An easier and faster procedure can be achieved when a right-handed surgeon performs LP procedure on the left side and RP procedure on the right side. There was no persistence of PUJ obstruction in any patient.

Conclusion: Pyeloplasty done by laparoscopic technique is a convenient alternative of the treatment of the PUJ stenosis, especially when the presence of aberant renal vessels is suspected. Apart from escaping lumbotomy it ensures higher quality of postoperative course and a faster recovery. The duration of the procedure can be decreased by a correct indication of LP or RP accesss.

Keywords: laparoscopy, retroperitoneoscopy, pyeloplasy, hydronefrosis

Published: September 1, 2003