Die laparoskopische nierenbeckenplastik: Probleme und lösungen

During the past few years, laparoscopic pyeloplasty for ureteropelvic junction (UPJ) obstruction has gained increasing popularity. Despite technical improvements the optimum management of problems like concomitant nephrolithiasis or urine extravasation is still unclear. At our institution, laparoscopic pyeloplasty for UPJ obstruction was performed in 54 patients. 5 individuals showed nephrolithiasis with 6 to 120 calculi. Stones were removed intraoperatively by means of flexible nephroscopy. During the last 16 procedures the anastomosis was sealed with fibrin glue. Patients, who had undergone percutaneous nephrostomy or nephrolithotomy for stone removal showed massive scar formation around the renal pelvis making surgery more difficult and resulting in prolonged urine extravasation. In none of the patients presenting with nephrolithiasis, calculi could be removed completely with flexible nephroscopy. Urine extravasation was avoided successfully by means of fibrin glue.