الفهرس 
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Abstract
Introduction: Traditionally, open pyeloplasty has been considered the ”gold standard” for treatment of ureteropelvic junction obstruction (UPJO). However, since the 1980s, minimally invasive treatment modalities started to gain acceptance as valuable alternatives to open surgery. Objectives: This study was conducted for evaluation of minimally invasive management of UPJO. Patients and Methods: In the retrospective part, we reviewed our experience with percutaneous endopyelotomy over the past 15 years. The procedure was carried out for 92 patients. Short-term outcome was available for 72 patients. The success rate was 72% (52 patients). Long-term follow-up was available for 50 patients. Recurrence of UPJO developed in 7 of them (14%). We investigated the influence of all variables on short-term success and late recurrence rates. The prospective part of the study included 80 patients. Preoperative radiologic investigations included IVU, diuretic renography and multiphasic helical CT. Selection of the suitable treatment modality depended on the results of radiologic investigations. 46 patients underwent pyeloplasty (23 open and 23 laparoscopic). The other 34 patients were randomized between ureteroscopic endopyelotomy using Holmium: YAG Laser and retrograde Acucise endopyelotomy. Subjective and objective evaluation of the outcome was carried out after 3 and 6 months in the first year then every 6 months. Results: Significant factors affecting success of percutaneous endopyelotomy were grade of hydronephrosis and type of UPJO. Significant factors influencing late recurrence were high preoperative serum creatinine, development of complications and repetition of endopyelotomy. CT angiography detected significant crossing vessels in 55% of the patients. The comparison between Laser and Acucise endopyelotomy demonstrated more safety and better outcome for Laser. The complications of the Acucise were higher than Laser (31.2% for Acucise versus 12.5% for laser). Successful outcome was achieved in 81% after laser compared to 68% after Acucise. The comparison of open and laparoscopic approaches for dismembered (Anderson Hynes’) pyeloplasty revealed higher intraoperative complications for laparoscopic (8.7% versus 4.3%). However, postoperative morbidity was more with open surgery (21.7% versus 8.7%). Equivalent outcome was achieved with both approaches (85.7% success rate with laparoscopy and 86.4% with open surgery). Laparoscopic approach showed the advantages of shorter hospital stay (3.4 versus 9.9 days) and early convalescence (12.1 versus 20 days). Conclusions: Proper selection of patients for endopyelotomy is the key to success. Preoperative multiphasic helical CT is helpful to facilitate selection of proper treatment modality of UPJO. The safety and efficacy of Laser endopyelotomy are better than Acucise. Laparoscopic pyeloplasty is equivalent to the gold standard open surgery with the added advantages of being minimally invasive technique.