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    Korean J Urol. 2006 Dec;47(12):1302-1308. Korean.
    Published online Dec 31, 2006.
    https://doi.org/10.4111/kju.2006.47.12.1302
    Copyright © 2006 The Korean Urological Association
    Original Article

    Initial Experience of Laparoscopic Pyeloplasty: Retrograde Stenting Using Flexible Cystoscopes

    Bum Sik Kim, Seung Hyo Woo, Hyun Young Han,1 and Seung Bae Lee
      • Department of Urology, Eulji University, Daejeon, Korea.
      • 1Department of Diagnostic Radiology, Eulji University, Daejeon, Korea.
    • Corresponding author (Email: sblee@eulji.ac.kr )
    Received June 09, 2006; Accepted August 07, 2006.

    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

    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.

    Fig. 2
    Laparoscopic view of a double J stent insertion: black indicator of double J stent is passing by the anastomosis site (lower).

    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.

    Tables

    Table 1
    Patient characteristics & radiologic outcomes

    Table 2
    Operative results

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    MeSH Terms
    Cystoscopes*
    Cystoscopy
    Female
    Flank Pain
    Humans
    Hydronephrosis
    Laparoscopy
    Male
    Medical Records
    Pyelonephritis
    Recurrence
    Retrospective Studies
    Stents*
    Ureter
    Ureteral Obstruction
    Metrics
    Share
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