Retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope in the treatment of ureteropelvic junction obstruction with coexistent stone disease
Liu Qiming1, Ma Xin1, Zheng Tao1, Yu Hongkai1, Zhang Xu1
1Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
Abstract:Objective:To evaluate the feasibility, efficacy and safety of the retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope in the treatment of ureteropelvic junction obstruction with coexistent stone disease.Methods:We reviewed data on 5 patients undergoing laparoscopic pyeloplasty through retroperitoneal approach and pyelolithotomy with flexible cystoscope between January 2012 and March 2013. The clinic parameter involves operational time, blood loss, postoperative hospital stay, the status of stone-free, perioperative complications, conversion to open procedure, the follow-up of radiology.Results:No procedure converted to open surgery. The mean operational time is 126 mins(ranged from 90 to 170 mins). One patient had one residual calculi encrusted in a calyx with obstructive neck indicated by the postoperative radiological image. The blood loss ranged from 10 to 30 mins. The urinary leak happened in one patient who got recovered after 6 days conservative treatment. The mean postoperative hospitality is 8 days (ranged 6-12 days). The mean period of follow-up is 6 months (ranged 1-9 months).Conclusions:The retroperitoneal laparoscopic pyeloplasty combined with flexible cystoscope is a feasible, efficient and safe minimally invasive technique in the treatment of ureteropelvic junction obstruction with coexistent stone disease.
[1]张旭,李宏召,马鑫,等.后腹腔镜离断性肾盂成形术(附22例报告).临床泌尿外科杂志, 2003,18(12):707-708. [2]Schuessler WW, Grune MT, Tecuanhuey LV,et al. Laparoscopic dismembered pyeloplasty. J Urol, 1993,150(6):1795-1799. [3]Nakada SY, McDougall EM, Clayman RV. Laparoscopic pyeloplasty for secondary UPJ obstruction. Urology, 1995,46(2):257-260. [4]Chen RN, Moore RG, Kavoussi LR. Laparoscopic pyeloplasty. Indications, technique, and long-term outcome. Urol Clin North Am,1998,25(2):323-330. [5]Bauer JJ, Bishoff JT, Moore RG, et al. Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol,1999,162(3 pt 1):692-695. [6]Janetschek G, Peschel R, Franscher F. Laparoscopic pyeloplasty. Urol Clin North Am, 2000,27(4):695-704. [7]Al-Hunayan A, Abdulhalim H, Kehinde EO. Laparoscopic pyelolithotomy: is the retroperitoneal route a better approach. Int J Urol,2009,16(2):181-186. [8]Bernardo NO, Liatsikos EN, Dinlenc CZ, et al. Stone recurrence after endopyelotomy. Urology,2000,56(3):378-381. [9]Patrick Richard, Mathieu Bettez, Arold Martel, et al. Laparoscopic management of a large staghorn stone. Can Urol Assoc J, 2012,6(3): E121-E124. [10]Weizer AZ, Springhart WP, Ekeruo WO, et al. Ureteroscopic management of renal calculi in anomalous kidneys. Urology,2005, 65(2): 265-269. [11]Braz Y, Ramon J, Winkler H. Ureterorenoscopy and holmium laser lithotripsy for large renal stone burden: A reasonable alternative to percutaneous nephrolithotomy. Eur Urol,2005,Suppl 4(3): 264. [12]Whelan JP,Wiesenthal JD. Laparoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible ureteroscope. Can J Urol,2004,11(2): 2207-2209. [13]Ramakumar S, Lancini V, Chan DY. Laparoscopic pyeloplasty with concomitant pyelolithotomy. J Urol, 2002,167(3):1378-1380. [14]Chen Z, Zhou P, Yang ZQ, et al. Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones. PLoS One, 2013,8(1): e55026.