Patient Selection And Diagnosis

The indications for laparoscopic pyeloplasty include ureteropelvic junction obstruction associated with the following:

1. Flank pain

2. Deteriorating renal function

3. Renal calculus

4. Urinary tract infections

5. Associated hypertension

Diagnosis of ureteropelvic junction obstruction is based on radiography. Ultrasound, computed tomography, and intravenous pyelography are capable of identifying suspicious hydronephrotic kidneys. Often additional testing is necessary to confirm ureteropelvic junction obstruction. Retrograde pyelogram is often used to help identify the level of obstruction. A characteristic "jet" of contrast is seen at the area of narrowing during retrograde injection of contrast. Diuretic renography can often differentiate between the nonobstructed and obstructed ureteropelvic junction obstruction. Furthermore, if significant cortical loss is evident on radiography, nuclear renography can quantify renal differential function. If 20% or less of total renal function is present, a simple nephrectomy may be preferable to pyeloplasty.

Diuretic renogram can also document postoperative functional improvement, both with respect to renal function and the presence/absence of obstruction. Be aware that the results of diuretic renogram can be confounded by poor renal function and excessive renal pelvic redundancy.

Relative contraindications for laparoscopic pyeloplasty include:

1. Previous open renal surgery

2. Bleeding diathesis

3. Untreated active pyelonephritis

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