Search

Background and Objective Laparoscopic dismembered pyeloplasty for correction of ureteropelvic junction obstruction (UPJO) in the pediatric population is comparable to open dismembered pyeloplasty in success rates. Experience with this procedure however remains limited. We review our experience with this technique.Patients and Methods The hospital records of consecutive patients undergoing surgery for UPJO between May 2001 and May 2005 were reviewed. Only those who underwent laparoscopic pyeloplasty for single system UPJO were included in the study. Indications for surgical correction were T12≥ 20 minutes by diethylene triamine pentaacetic acid Lasix renography or symptomatology with hydronephrosis seen on renal ultrasonography (US).Results Fifty-nine patients were identified, all of whom were treated surgically for salvageable UPJO. Four underwent percutaneous endopyelotomy for concomitant urolithiasis, 27 underwent open dismembered pyeloplasty (parent choice or under 18 months of age), and 28 underwent laparoscopic dismembered pyeloplasty. One patient had bilateral laparoscopic repairs at different times, resulting in 29 renal units that were reconstructed laparoscopically. Of these, 28 were completed. Eighteen procedures were performed on boys and 11 on girls. The mean age was 8.1 (1.6–18.9) years. The mean operating room time was 255 (157–396) minutes. Estimated blood loss was <10 mL in every patient. One patient required hospitalization longer than 23 hours because of postoperative ileus. A retroperitoneal urinoma developed in another patient, despite having a ureteral stent; it resolved with urethral catheter drainage. The first laparoscopic pyeloplasty resulted in open conversion because of failure of progression of the ureteropelvic anastomosis. At a mean follow-up of 27.9 (7.6–58.0) months, all patients demonstrated improvement of symptoms and drainage on nuclear renography or a decrease in the grade of hydronephrosis on renal US.Conclusion Our series of patients undergoing laparoscopic pyeloplasty had excellent results with low morbidity. We consider this our primary technique for surgical correction of UPJO in patients older than 18 months. [ABSTRACT FROM AUTHOR]

Background and Purpose Patients with urinary diversions are at higher risk for bladder urolithiasis. Often, the stone burden is large, necessitating open stone removal. We describe our technique for removing such stones using a combination of laparoscopic and endourologic instrumentation.Patients and Methods With the patient in the dorsal lithotomy position or supine, cystoscopy is performed via the native urethra or catheterizable stoma, respectively. With the urinary reservoir distended with normal saline, percutaneous access is obtained under direct vision with a 10-mm trocar introduced through the scar of the previous suprapubic cystostomy. A laparoscopic entrapment bag is introduced through the trocar, into which the calculi are manipulated. The bag is delivered percutaneously through the trocar site with subsequent removal of the trocar. A 30F Amplatz renal dilator sheath (Cook Urological, Spencer, IN) is introduced directly into the bag. An ultrasonic lithotrite passed through a nephroscope is utilized to fragment and evacuate the calculi. Closure of the neocystotomy is not performed. A drainage catheter is left in for 7 days.Results This procedure has been successful in eight consecutive patients, six with bladder augmentations, one with a bladder reconstruction with appendicovesicostomy, and one with an Indiana pouch. All calculi were radiopaque, having a mean linear size of 4.1 cm (range 1.5–7.0) cm. Several patients had multiple stones. The mean operating room time was 123 minutes (range 48–228 minutes). Two patients had concomitant ureteroscopy with laser lithotripsy for ureteral calculi. All were rendered stone free with one procedure and were discharged within 23 hours after surgery. There were no immediate or delayed complications.Conclusions Our technique of percutaneous cystolithotomy utilizing laparoscopic and endourologic instrumentation is safe and effective for the removal of large calculi from urinary diversions. It is well tolerated, allows complete stone removal in a single sitting, and obviates an open procedure. [ABSTRACT FROM AUTHOR]