Journal List > Korean J Urol > v.47(12) > 1069808

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Kim, Woo, Han, and Lee: Initial Experience of Laparoscopic Pyeloplasty: Retrograde Stenting Using Flexible Cystoscopes
Original Article
Korean Journal of Urology

Korean Journal of Urology 2006; 47(12): 1302-1308.

Published online: 31 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.12.1302

Initial Experience of Laparoscopic Pyeloplasty: Retrograde Stenting Using Flexible Cystoscopes

Bum Sik Kim, Seung Hyo Woo, Hyun Young Han1, Seung Bae Lee

Department of Urology, Eulji University, Daejeon, Korea.

1Department of Diagnostic Radiology, Eulji University, Daejeon, Korea.

Corresponding author (sblee@eulji.ac.kr)

Received 9 June 2006       Accepted 7 August 2006

Copyright © 2006 The Korean Urological Association

Abstract

Purpose

To describe our initial experience of laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, in 9 cases of ureteropelvic junction obstruction (UPJO).

Materials and Methods

Between September, 2004 and January, 2006, 9 cases of UPJO were treated by laparoscopic pyeloplasty. All of the medical records were reviewed retrospectively. The cases comprised of 5 males and 4 females, with a mean age of 37 years (13-58). All patients showed a preoperative grade 4 hydronephrosis.

Results

Two laparoscopic pyeloplasty approaches were performed; a transperitoneal approach in 5 cases and a retroperitoneal approach in the other 4. All cases were treated with dismembered Anderson-Hynes pyeloplasty. The mean operating time was 249 minutes (170-324), including a mean of 7.1 minutes (6.5-8) for ureteral stenting. The patients were found to have aberrant vessels and renal stones in 1 and 3 cases, respectively. There were no intra-operative complications or open conversion. Of the 9 cases, 8 (89%) showed a decrease in their hydronephrosis grade on the excretory urographs taken 12 weeks postoperatively. The remaining case showed a marked improvement in the hydronephrosis, despite having no change in the hydronephrosis grade. No case experienced postoperative flank pain or recurrence of acute pyelonephritis. Therefore, symptomatic improvements were observed in all our cases (100%).

Conclusions

Laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, can be considered an effective and convenient method for the treatment of UPJO.

Keywords: Ureteral obstruction, Laparoscopy, Cystoscopy

Figures and Tables

Fig. 1
Port sites for transperitoneal (A) and retroperitoneal (B) laparoscopic pyeloplasty. 1. 10mm Hasson trocar, 2. Rt. side operation: 11mm trocar is used, Lt. side operation: 5mm trocar is used, 3. Rt. side operation: 5mm trocar is used, Lt. side operation: 11mm trocar is used. AAL: anterior axillary line, MAL: mid-axillary line, PAL: posterior axillary line.
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Fig. 2
Laparoscopic view of a double J stent insertion: black indicator of double J stent is passing by the anastomosis site (lower).
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Fig. 3
A (preoperative) and B (postoperative) show no change in the hydronephrosis grade from preoperative grade 4/4 to postoperative grade 4/4. However, the postoperative film shows a marked decrease in the dilation of the pelvis and calyces.
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Table 1
Patient characteristics & radiologic outcomes
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APN: acute pyelonephritis

Table 2
Operative results
kju-47-1302-i002

RP: retroperitoneal, TP: transperitoneal, EBL: estimated blood loss

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