724 RESULTS OF CONVENTIONAL (LPP) AND ROBOT ASSISTED (RALPP) LAPAROSCOPIC PYELOPLASTY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy I1 Apr 2010724 RESULTS OF CONVENTIONAL (LPP) AND ROBOT ASSISTED (RALPP) LAPAROSCOPIC PYELOPLASTY Hansjoerg Danuser, Patrick Stucki, and Agostino Mattei Hansjoerg DanuserHansjoerg Danuser More articles by this author , Patrick StuckiPatrick Stucki More articles by this author , and Agostino MatteiAgostino Mattei More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1212AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the past ureteropelvic junction obstruction (UPJO) has been treated by different open techniques as well as different retro- and antegrade endopyelotomies. Today laparoscopic (LPP) or roboter assisted laparoscopic pyeloplasty (RALPP) are promising minimal invasive procedures with a high success rate. We present the results of 60 patients undergoing LPP and RALPP. METHODS 60 patients were planned to undergo LPP (34) or RALPP (26). Preoperative work-up included an IV-urography or CT-Scan and a diuretic renography or in case of a nephrostomy split renal function by a creatinine clearance. Every patient had a retrograde ureteropyelography followed by insertion of a 6 Fr JJ-stent. 34 patients were planned to undergo LPP and 26 patients RAL-PP as soon as the Da Vinci system was available. Technically we performed a dismembered pyeloplasty (Anderson Hynes). A bladder catheter was left for 2 days postop. to drain the bladder and the upper urinary tract. The JJ-stent was removed 1-4 weeks postoperatively according to a prospective study. Follow-up controls were planned 3 months postop. with an IV-urography, 6 months postop. with a diuretic renography and ultrasound, 1 and 3 years postop. with a ultrasound repeating this study afterwards every 3 year, provided the patient remained without symptoms. The mean follow-up was 14±13 months, the median 11 (1-47) months. RESULTS Median age was 39 (15-80) years, 26 females, 34 males. In 3 patients the intervention was converted to a open procedures, in 2/3 cases due to extensive abdomial scaring; they were treated by a successful open Anderson Hynes procedure. In 1/3 cases after an unsuccessful endopyelotomy the distance between renal pelvis and the healthy ureter was to short, solving the problem with a successful open pyeloplasty according to Patel. Peri-/postoperative complications were minor and occurred in 9%: Dislocation of the stent (2), obstruction of the stent (1), severe urinary tract infection (1), delayed restitution of the reactive bowel paralysis (1) and severe bladder irritation by the stent (1). None of the 57 patients treated by LPP and RAL-PP had objective signs of obstruction, 52/57 (91%) patients were free of symptoms, 5/57 (9%) patients hat slight flank symptoms, but without objective signs in the IVU and/or diuretic renography. CONCLUSIONS Minimal invasive L-PP or RAL-PP are safe procedures with an excellent success rate similar as in open pyeloplasties, but with the advantage of little invasiveness. Luzern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e282-e283 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hansjoerg Danuser More articles by this author Patrick Stucki More articles by this author Agostino Mattei More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...