Caveats

■ Incomplete transection of the ureter before performing a dismembered pyeloplasty prevents retraction of the renal pelvis and the problematic introduction of any further instrument for stone removal.

■ Initial pyelotomy through which the stones are removed should be kept as small as possible to prevent avulsion of the ureteropelvic junction during manipulations.

Laparoscopic pyelolithotomy is feasible when combined with pyeloplasty. Although technically demanding, the results obtained are comparable to those of stone removal during open pyeloplasty or percutaneous endopyelotomy. The advantages of open surgery appear to be maintained in this minimally invasive approach.

Laparoscopic pyeloplasty in the setting of an ectopic or horseshoe kidney has been performed successfully. Trocar positioning can be different for abnormally located kidneys and should be individualized. The overall success rate in the only series presented by Bove et al. is 91% and is higher than those reported for either open repair (55-80%) or endoscopic management (78%) of ureteropelvic junction obstruction in such kidneys.

Both dismembered and nondismembered techniques have been used. Despite long operating times (mean 4.6 hours), no complication occurred and hospital stay was short (3.4 days). Stone free and pyeloplasty success rates were both 90%.

Laparoscopic pyelolithotomy is feasible when combined with pyeloplasty. Although technically demanding, the results obtained are comparable to those of stone removal during open pyeloplasty or percutaneous endopyelotomy. The advantages of open surgery appear to be maintained in this minimally invasive approach.

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