Nondismembered pyeloplasty

Abstract

Introduction: Despite of wide spread of dismembered pyeloplasty, in some cases like lengthy ureteral stricture and a poorly accessible intrarenal pelvis this type of pyeloplasty are not favorable. Nondismembered techniques like Foley Y-V and Fenger, being technically less demanding and intuitively less traumatic to the ureter’s nerves and vasculature in selected cases may have some advantages over dismembered techniques. This study was undertaken to document our experience with nondismemberedpyeloplasty in adults; the primary aims were to determine the indications and overall success rate. Materials and methods: This study included 10 patients (6 male and 4 female, mean age 36,1 years, range 21 -62) who underwent nondismembered pyeloplasty in the Department of Urology from Clinical Republican Hospital between January 2009 and November 2014. Preoperatively, all patients were evaluated with intravenous urography and isotope scans. The uretero-pelvic junction obstruction (UPJO) was corrected by either Fengerplasty (4) or Foley Y-V plasty (6). Results: In all cases nondismembered pyeloplasty were performed in patients with small symptomatic hydronephrosis. When the etiology of UPJO was a high ureteral insertion we performed more often Fenger (75%) then Foley Y-V pyeloplasty (16,7%). In the presence of congenital stenosis the first choice was Foley Y-V pyeloplasty (83,3%). The mean operative time was 93,7 minutes. No intraoperative complications were seen. Mean postoperative hospitalization 13,3 days. The only postoperative complication was a case of pyelonephritis that occurred in a patient with UPJO and concomitant urolithiasis. After 12 months of follow-up there has been no evidence of obstruction, complete resolution of clinical symptoms was achieved in all patients. Conclusions: In selected cases nondismembered pyeloplasty could be a good treatment option for patients with UPJO. Being simpler from technical point of view they allow us to achieve same high result as dismembered techniques.