الفهرس 
Laparoscopic pyeloplasty in special situationsOnly 14 pages are availabe for public view
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Abstract
Obstruction of the uretro-pelvic junction (UPJ) is the most common congenital abnormality of the ureter with reported incidence of 5/100.000 annually
UPJO may due to intrinsic factors such as insufficient emptying, valvular mucosal folds, ureteral polyps, persistent fetal convolutions and high insertion ureter or due to extrinsic factors such as crossing vessels, secondary to VUR or secondary to iatrogenic trauma to UPJ.
Diagnosis of UPJO depends mainly nowadays on prenatal U/S, although UPJO can be presented postnatal with pain, recurrent UTI, 2ry renal stones, haematuria and renal hypertension with renal impairment as a late complication of UPJO.
Certain investigations may be needed for diagnosis of UPJO. These investigations included U/S, diuretic renal scan, dynamic contrast material enhanced MR urography, voiding urethrocystography and sometimes IVP.
UPJO can be treated by open pyeloplasty, endoscopic endopyelotomy and laparoscopic pyeloplasty.
In 1993, the first case of laparoscopic repair of uretro-pelvic junction obstruction via the transperitoneal approach was described.
Laparoscopic pyeloplasty aims to combine the same excellent results of open pyeloplasty with avoidance of substantial wound, and so, has three potential advantages, less pain, shorter hospital stay and better esthetics.
There has been ongoing debate on the merits of intubated versus non-intubated repair of pelvi-ureteric junction obstruction. Many authorities recommend tube for the fear, that edema at the anastomotic site leads to occlusion of the lumen post-operatively. On the other hand, the presence of stent acts as a foreign body leading to increase incidence of urinary tract infection post-operatively and finally disruption of anastomosis.
In our series we tried to offer the ideal solution for this debate. We tried to use fibrin glue as a sealant for anastomotic line to prevent urinary leakage and in the same time avoid the disadvantages of the ureteric stent.
We had 46 patients with non recurrent UPJO who were divided into 2 equal group. The first group underwent laparoscopic stented pyeloplasty and the second group underwent laparoscopic non stented pyeloplasty sealed with fibrin glue.
We compared both groups as regards early postoperative data as urinary leakage, hospital stay, early postoperative complications as irritative LUTS, haematuria, lower pyuria and reflux pyelonephritis.
Three months postoperative we also compared both groups as regards success which evaluated with IVP and diuretic DTPA renal scan.
After evaluation of the above mentioned data we found no difference between both groups as regards urinary leakage and hospital stay. There was marked increase of early postoperative complications especially irritative LUTS and lower UTI in stented group.
As regards postoperative success rate we did not found any significant statistical difference between both groups as shown in both IVP and diuretic DTPA renal scan.
Finally, after reviewing our series results we can consider sealing of the non stented pyeloplasty repair with fibrin glue as an efficient method for UPJO carrying the same outcomes and advantages of the stented pyeloplasty, but without the stent complications.