Laparoscopic pyeloplasty for secondary XXXX .

@entity1 @entity834 @entity55 @entity384 @entity1483 @entity260 @entity425 @entity891 @entity158 @entity221 @entity293 @entity4145 @entity3816
PURPOSE: Laparoscopic pyeloplasty has become a viable option for the treatment of select @entity1 with primary @entity4145 with success rates similar to those of open surgery. However, little has been written on the application of this technique for secondary @entity4145 . We report the largest series of secondary @entity4145 managed by laparoscopic pyeloplasty. MATERIALS AND METHODS: Between March 1994 and March 2001, 36 @entity1 underwent laparoscopic transperitoneal pyeloplasty for secondary @entity4145 . The @entity1 had undergone an average of 1.3 ureteropelvic junction procedures (range 1 to 4) prior to presentation, including cutting balloon retrograde endopyelotomy in 28, antegrade endoscopic endopyelotomy in 7, retrograde endoscopic endopyelotomy in 4, @entity384 in 4 and open pyeloplasty in 3. A preoperative diagnosis of recurrent obstruction was confirmed by renal scan in 31 cases, retrograde pyelography in 2 and computerized tomography in 3. Of the 31 @entity1 who underwent spiral computerized tomography angiogram 87% had crossing vessels. Laparoscopic repair comprised dismembered pyeloplasty in 31 cases, Fengerplasty in 3 and flap repair in 2. Postoperative renal scan or excretory urography objective followup was available for all @entity1 at a mean of 10 months (range 3 to 40). Postoperative subjective @entity1 well-being was assessed using an analog @entity158 scale at a mean followup of 21.8 months (range 3 to 85). RESULTS: Average operative time was 6.2 hours (range 2.7 to 10). Average hospital stay was 2.9 days (range 1 to 7). One @entity3816 occurred, that is bleeding necessitating conversion to an open procedure. @entity260 occurred in 8 cases, including @entity834 in 4, and @entity293 , @entity55 , @entity891 , @entity221 , @entity425 and stone formation 2 months postoperatively in 1 each. On excretory urography, @entity1483 renal scan or the Whitaker test 32 of 36 @entity1 (89%) had a widely patent ureteropelvic junction. Two @entity1 (5.5%) had equivocal radiographic studies but were asymptomatic. In 2 @entity1 the ureteropelvic junction was obstructed by renal scan. One @entity1 had an indwelling stent for renal function deterioration and 1 was asymptomatic. Hence, 34 of the 36 @entity1 (94%) had a reasonable objective response. Overall a 50% or greater decrease in @entity158 was seen in 32 of 36 @entity1 (89%). In the 4 @entity1 with a less than 50% decrease in @entity158 objective renal scans showed an open ureteropelvic junction. As such, the overall success rate of a greater than 50% decrease in @entity158 , a patent ureteropelvic junction and stable or improved function of the affected renal unit was 83% (30 of 36 @entity1 ). CONCLUSIONS: For secondary @entity4145 , laparoscopic pyeloplasty can be performed safely with a success rate comparable to that of standard open pyeloplasty. The @entity1 benefits of laparoscopic ureteropelvic junction repair of secondary @entity4145 are similar to the benefits of laparoscopic repair of primary @entity4145 .
