Introduction

Ureteropelvic junction obstruction leads to progressive dilatation of the renal collecting system and can result in progressive deterioration of renal function. Most cases are congenital; however, symptoms are not clinically apparent until later in life. Most frequent presenting symptoms are flank pain, urinary tract infection, and hematuria after minor trauma. It is the most common site of obstruction in the upper urinary tract, and surgical management is necessary when obstruction is confirmed with functional radiographic studies.

The gold standard therapy for repair of ureteropelvic junction obstruction has been open pyeloplasty with long-term success rates consistently exceeding 90% (1,2).

In an attempt to reduce the morbidity of the flank incision, new minimally invasive procedures, endoscopic or fluoroscopic retrograde, and endoscopic percutaneous antegrade pyelotomy were developed (3-6). All achieved the goals of short hospital stay and rapid recovery, but had lower success rates.

In an effort to achieve both minimal morbidity and results equivalent to or better than those of open surgery, laparoscopic dismembered pyeloplasty was introduced in 1993 (7,8). Initial promising results were confirmed by larger series (9-12). Despite the existing long learning curve, laparoscopic pyeloplasty is now an established procedure at select centers worldwide, applicable to both pediatric (13,14) and adult patient populations.

Dismembered and nondismembered pyeloplasties [Foley Y-V (15), Fenger (16)] may be performed using transperitoneal and retroperitoneal laparoscopic approaches.

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