Retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction_West China Medical Journal

Authors：

 LIU Yang

Department of Urology, the people’s Hospital of Pengzhou, Pengzhou, Sichuan 611930, P. R. China;

Corresponding?author：

LIU Yang, Email: 22256006@qq.com

Keywords：

Ureteropelvic junction obstruction; Dismembered pyeloplasty; Retroperitoneal laparoscopy

DOI：

10.7507/1002-0179.201603058

Video：

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Objective To investigate the clinical effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction (UPJO). Methods From November 2010 to September 2015, a total of 28 cases (21 males and 7 females) with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal laparoscopic dismembered pyeloplasty. All the 28 patients had a previous history of different degrees of lumbar pain, which was confirmed as typical UPJO by imaging examination. Operation method: following complete renal pelvis and upper ureter isolation, the renal pelvis was clipped into a trumpet-shaped mouth, 1/3 of the upper renal pelvis was temporarily kept without section. In the inferior margin of renal pelvis, longitudinal cut procedure was operated in the ureter and across the stenotic segment in about 1–2 cm; and then, anastomosis of the ureter and the renal pelvis at the lowest was performed, to maintain the continuity of the renal pelvis and ureter. Subsequently, the stenosed segment of ureter and the dilatant renal pelvis were removed, the posterior ureteropelvic anastomosis was made with an interrupted suture, and antegrade stenting of double J tube was further performed, followed by a continuous suture of the anterior wall. Results The procedure was successfully accomplished in all patients whithout conversion to open surgery. The operating time was 90-240 minutes with the median time of 160 minutes. The estimated blood loss was 20-70 mL with the median of 50 mL. No severe surgical complication occurred in perioperative period. The 3-24 -month follow up showed that symptoms of lumbar pain were relieved or disappeared in all the incorporated patients. Postoperative radiographic examination showed no stomal stenosis at the ureteropelvic junction, and the hydronephrosis was alleviated. Conclusions Retroperitoneal laparoscopic dismembered pyeloplasty for UPJO is an effective, safe, and minimally invasive surgical technique. The key to the success of the operation is to the accurate renal pelvis clipping, tension- and torsion-free anastomosis of the lowest position of the renal pelvis and the ureter, and the reconstruction of a new funnel-shaped ureteropelvic junction.

Citation： LIU Yang. Retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction. West China Medical Journal, 2017, 32(6): 862-866. doi: 10.7507/1002-0179.201603058 Copy

1.	Srivastava A, Singh P, Maheshwari R, et al. Laparoscopic pyeloplasty: a versatile alternative to open pyeloplasty. Urol Int, 2009, 83(4): 420-424.
2.	Anderson JC, Hynes W. Retrocaval ureter: a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol, 1949, 21(3): 209-214.
3.	O’reilly PH, Brooman PJ, Mak S, et al. The long-term results of Anderson-Hynes pyeloplasty. BJU Int, 2001, 87(4): 287-289.
4.	Kinn AC. Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment. J Urol, 2000, 164(3 Pt 1): 652-656.
5.	Heinlen JE, Manatt CS, Bright BC, et al. Operative versus nonoperative management of ureteropelvic junction obstruction in children. Urology, 2009, 73(3): 521-525; discussion 525.
6.	Hasgim H, Woodhouse C. Ureteropelvic junction obstruction. Eur Urol Suppl, 2012, 11(2): 25-32.
7.	Tekgul S, Riedmiller E, Gerharz P, et al. Paediatric urology// European Association of Urology. European Association of Urology Guidelines. Arnhem: European Association of Urology, 2008: 6-78.
8.	Baldwin DD, Dunbar JA, Wells N, et al. Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol, 2003, 17(3): 155-160.
9.	Doo CK, Hong B, Park T, et al. Long-term outcome of endopyelotomy for the treatment of ureteropelvic junction obstruction: how long should patients be followed up?. J Endourol, 2007, 21(2): 158-161.
10.	Janetschek G, Pesehel R, Altarac S, et al. Laparascopic and retroperitoneoscopic repair of ureteroneoscopic repair of ureteropelvic junction obstruction. Urology, 1996, 47: 311-314.
11.	Puri P, Hollwarth M. Pediatric surgery: diagnoms and management. Springer-Verlag Berlin and Heidelberg GmbH & Co. K, Berlin. 2009: 839-847.
12.	Walsh PC, Retik AB, Vanghan ED, et al. 坎貝爾泌尿外科學. 北京: 科學出版社, 2001: 1739-1749.
13.	Troxel S, Das S, Helfer E, et al. Laparoscopy versus dorsal lumbotomy for ureteropelvic junction obstruction repair. J Urol, 2006, 176(3): 1073-1076.
14.	Calvert RC, Morsy MM, Zelhof B, et al. Comparison of laparoscopic and open pyeloplasty in 100 patients with pelvi-ureteric junction obstruction. Surg Endosc, 2008, 22(2): 411-414.
15.	Penn HA, Gatti JM, Hoestje SM, et al. Laparoscopic versus open pyeloplasty in children: preliminary report of a prospective randomized trial. J Urol, 2010, 184(2): 690-695.
16.	Rassweiler J, Frede T, Henkel TO, et al. Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol, 1998, 33(5): 489-496.
17.	張旭, 李宏召, 馬鑫, 等. 后腹腔鏡離斷性腎盂成形術 (附 22 例報告). 臨床泌尿外科雜志, 2003, 18(12): 707-708, 710.
18.	朱有華, 徐丹楓, 曾力, 等. 泌尿外科診療手冊. 北京: 人民衛生出版社, 2013: 741-744.
19.	Mandhani A, Goel S, Bhandari M. Is antegrade stenting superior to retrograde stenting in laparoscopic pyeloplasty?. J Urol, 2004, 171(4): 1440-1442.

1. Srivastava A, Singh P, Maheshwari R, et al. Laparoscopic pyeloplasty: a versatile alternative to open pyeloplasty. Urol Int, 2009, 83(4): 420-424.
2. Anderson JC, Hynes W. Retrocaval ureter: a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol, 1949, 21(3): 209-214.
3. O’reilly PH, Brooman PJ, Mak S, et al. The long-term results of Anderson-Hynes pyeloplasty. BJU Int, 2001, 87(4): 287-289.
4. Kinn AC. Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment. J Urol, 2000, 164(3 Pt 1): 652-656.
5. Heinlen JE, Manatt CS, Bright BC, et al. Operative versus nonoperative management of ureteropelvic junction obstruction in children. Urology, 2009, 73(3): 521-525; discussion 525.
6. Hasgim H, Woodhouse C. Ureteropelvic junction obstruction. Eur Urol Suppl, 2012, 11(2): 25-32.
7. Tekgul S, Riedmiller E, Gerharz P, et al. Paediatric urology// European Association of Urology. European Association of Urology Guidelines. Arnhem: European Association of Urology, 2008: 6-78.
8. Baldwin DD, Dunbar JA, Wells N, et al. Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol, 2003, 17(3): 155-160.
9. Doo CK, Hong B, Park T, et al. Long-term outcome of endopyelotomy for the treatment of ureteropelvic junction obstruction: how long should patients be followed up?. J Endourol, 2007, 21(2): 158-161.
10. Janetschek G, Pesehel R, Altarac S, et al. Laparascopic and retroperitoneoscopic repair of ureteroneoscopic repair of ureteropelvic junction obstruction. Urology, 1996, 47: 311-314.
11. Puri P, Hollwarth M. Pediatric surgery: diagnoms and management. Springer-Verlag Berlin and Heidelberg GmbH & Co. K, Berlin. 2009: 839-847.
12. Walsh PC, Retik AB, Vanghan ED, et al. 坎貝爾泌尿外科學. 北京: 科學出版社, 2001: 1739-1749.
13. Troxel S, Das S, Helfer E, et al. Laparoscopy versus dorsal lumbotomy for ureteropelvic junction obstruction repair. J Urol, 2006, 176(3): 1073-1076.
14. Calvert RC, Morsy MM, Zelhof B, et al. Comparison of laparoscopic and open pyeloplasty in 100 patients with pelvi-ureteric junction obstruction. Surg Endosc, 2008, 22(2): 411-414.
15. Penn HA, Gatti JM, Hoestje SM, et al. Laparoscopic versus open pyeloplasty in children: preliminary report of a prospective randomized trial. J Urol, 2010, 184(2): 690-695.
16. Rassweiler J, Frede T, Henkel TO, et al. Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol, 1998, 33(5): 489-496.
17. 張旭, 李宏召, 馬鑫, 等. 后腹腔鏡離斷性腎盂成形術 (附 22 例報告). 臨床泌尿外科雜志, 2003, 18(12): 707-708, 710.
18. 朱有華, 徐丹楓, 曾力, 等. 泌尿外科診療手冊. 北京: 人民衛生出版社, 2013: 741-744.
19. Mandhani A, Goel S, Bhandari M. Is antegrade stenting superior to retrograde stenting in laparoscopic pyeloplasty?. J Urol, 2004, 171(4): 1440-1442.

West China Medical Journal

Retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction

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