COMPARATIVE STUDY BETWEEN NON-STENTED LAPAROSCOPIC PYELOPLASTY & NON-STENTED LAPAROSCOPIC PYELOPLASTY SEALED WITH FIBRIN GLUE IN THE TREATMENT OF PELVI-URETERIC JUNCTION OBSTRUCTION

Abstract

SUMMARY O bstruction 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. Certain investigations may be needed for diagnosis of UPJO. These investigations included U/S, IVP, diuretic renal scan, dynamic contrast material enhanced MR urography, and voiding urethro-cystography. Anderson-Hynes dismembered pyeloplasty was described for more than 60 years; however, it is still the gold standard therapeutic approach to ureteropelvic junction obstruction (UPJO) with success rate of this procedure is estimated as high as 90%. 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. Huge problems and significant adverse effects are associated with “indwelling ureteral stents” that include discomfort, infection, migration and encrustation, exposure of the upper urinary tract to high pressure during urination, and need for additional procedure and anesthesia exposure for removal. The overall name of which is a “stent syndrome”, which may lead to significant morbidity.