Anderson Hynes Dismembered Pyeloplasty

Anderson-Hynes dismembered pyeloplasty is preferred when pelvic reduction may be necessary, a renal calculus is present, or a crossing vessel is encountered (Fig. 3).

A dismembered pyeloplasty may have superior efficacy compared with the other nondismembered techniques. In the largest head-to-head comparison of laparoscopic dismembered (n = 25) and nondismembered pyeloplasties (n = 15), Klingler et al. showed superior efficacy for dismembered (96%) versus nondismembered (73.3%) pyeloplasty.

Once the ureteropelvic junction is dissected free, the narrowed segment is excised (Fig. 3A). If there is excessive redundant pelvis, this can be excised. The defect can be closed. Next, the ureter is spatulated (Fig. 3B). The 6 o'clock and 12 o'clock positions of

(A)

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(C)

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FIGURE 4 ■ Laparoscopic Foley Y-V plasty.

FIGURE 3 ■ Laparoscopic Anderson-Hynes disemebered pyeloplasty.

FIGURE 4 ■ Laparoscopic Foley Y-V plasty.

FIGURE5 ■ Laparoscopic Fenger pyeloplasty.

the ureter and pelvis are approximated (Fig. 3C). The intervening gaps on the front and back of the anastomosis can be closed with either running or interrupted suture.

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