Document Detail


Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty.
MedLine Citation:
PMID:  17296396     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: First line treatment of ureteropelvic junction obstruction is still open dismembered pyeloplasty. The development of videoendoscopic techniques like endopyelotomy and laparoscopy offers less invasive alternatives. The long-term outcome of an algorithm selectively using these techniques is presented. MATERIALS AND METHODS: From February 1995 to March 2006, 256 patients with ureteropelvic junction obstruction were treated with 113 laser endopyelotomies and 143 laparoscopic retroperitoneal pyeloplasties. According to changing selection criteria, an early group (92 in 1995 to 1999) treated with laser endopyelotomy for extrinsic as well as intrinsic stenoses, and a late group (164 in 2000 to 2006) treated with laser endopyelotomy for intrinsic stenosis, were evaluated. In the late group extrinsic ureteropelvic junction obstruction was treated with nondismembered pyeloplasty in cases of anteriorly and by dismembered pyeloplasty in cases of posteriorly crossing vessels or a redundant renal pelvis. RESULTS: Operating time of laser endopyelotomy averaged 34 (range 10 to 90) minutes with a complication rate of 5.3% and a success rate of 72.6% (intrinsic 85.7% vs extrinsic 51.4%). Operating time of laparoscopic retroperitoneal pyeloplasty averaged 124 (range 37 to 368) minutes with a 6.3% complication rate and an overall success rate of 94.4% (intrinsic 100% vs extrinsic 93.8%). In the late group the LAP success rate was 98.3% with no significant differences related to the cause of ureteropelvic junction obstruction (intrinsic 100% vs extrinsic 98.1%) or the type of pyeloplasty (YV plasty 97.0% vs Anderson-Hynes 97.7%). CONCLUSIONS: Laparoscopic retroperitoneal pyeloplasty yields an efficacy similar to that of open surgery. The inferior success of laser endopyelotomy even in optimally selected cases and the increasing expertise with endoscopic suturing may favor laparoscopic pyeloplasty with or without robotic assistance in the future.
Authors:
Jens J Rassweiler; Svetozar Subotic; Michaela Feist-Schwenk; Marto Sugiono; Michael Schulze; Dogu Teber; Thomas Frede
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  177     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-13     Completed Date:  2007-04-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1000-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany. jens.rassweiler@slk-kliniken.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms*
Child
Female
Follow-Up Studies
Humans
Kidney Pelvis*
Laparoscopy*
Laser Therapy*
Male
Middle Aged
Patient Selection
Retroperitoneal Space
Time Factors
Treatment Outcome
Ureteral Obstruction / diagnosis,  etiology,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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