ЛАПАРОСКОПИЧЕСКАЯ ПЛАСТИКА ПИЕЛОУРЕТЕРАЛЬНОГО СЕГМЕНТА С СИМУЛЬТАННОЙ ПИЕЛОЛИТОТОМИЕЙ

Abstract: To assess the efficiency of laparascopic pyelolithotomy and laparoscopic pyeloplasty (LP) in patients suffering from ureteropelvic junction (UPJ) obstruction in combination with renal stones. A total of 96 patients (42 males and 54 females) underwent laparoscopic pyeloplasty of UPJ at the urology clinic of North-Western State Medical University. The age of the patients ranged from 20 to 64 years (mean 30.4 ± 4.8 years). Fifty two patients underwent right laparoscopic pyeloplasty and 44 patients underwent left laparoscopic pyeloplasty. All procedures were performed using transperitoneal approach with the patient placed in lateral position. Fourteen patients (14.6%) who suffered from UPJ obstruction in combination with stones of kidney underwent laparoscopic pyelolithotomy followed by laparoscopic pyeloplasty. After the resection of UPJ intraoperative pyelocalicoscopy was performed using rigid ureteroscope, which provided the access for examination of all groups of renal calyxes with subsequent remove of the renal stones. No conversion was seen. The leakage of urine occurred in 4 patients. In 3 patients the leakage stopped spontaneously and 1 patient underwent laparoscopic re-pyeloplasty and suture of anastomotic disruption. Three patients experienced the recurrence of UPJ stricture, 2 of them underwent retrograde endopyelotomy and 1 of them underwent open re-pyeloplasty. These cases occured at the stage of experience acquisition. However, these patients did not undergo pyelolithotomy. The stones were fully removed in all patients and pyeloplasty was performed in all of 14 patients. We did not notice any postoperative complications. LP is defined as a procedure of choice in patients suffering of primary UPJ stricture. In the case of hydronephrosis coupled with renal stones intraoperative pyelocalicoscopy is preferred. The procedure should be performed using rigid ureteroscope, which provides a possibility to remove all stones with minimal postoperative risk of complications.

ureteropelvic junction, stricture, renal stones, pyelolithotomy, pyeloplasty, laparoscopy

1. Moon D.A., El-Shazly M.A., Chang C.M., Gianduzzo T.R., Eden C.G. Laparoscopic pyeloplasty: evolution of a new gold standard. // Urology 2006; 67: 932 – 936.

2. Rassweiler J., Subotic S., Feist-Schwenk M. et al. Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J. Urol. 2007, 177: 1000 – 1005.

3. Wagner H.C., Greco F., Inferrera A. et al. Laparoscopic dismembered pyeloplasty: Technique and results in 105 patients. World. J. Urol. 2010; 28: 615 – 618.

4. Комяков Б.К., Гулиев Б.Г., Алиев Р.В. Лапароскопическая пластика при первичных сужениях пиелоуретерального сегмента. // Урология. 2013; 6: 81 – 84.

5. Ramakumar S., Lancini V., Chan D.Y., Parsons J.K., Kavoussi L.R., Jarrett T.W. Laparoscopic pyeloplasty with concomitant pyelolithotomy. // J. Urol. – 2002. – Vol. 167. – P. 1378 – 1380.

6. Whelan J.P., Wiesenthal J.D. Laparoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible ureteroscope. // Can. J. Urol. – 2004. – Vol. 11. – P. 2207 – 2209.

7. Gomez Rivas J., Alonso Gregorio S., Cuello Sanchez L., de Castro Guerin C., Tabernero Gomez A., Hidalgo Togores L. Approach to kidney stones associated with ureteropelvic junction obstruction during laparoscopic pyeloplasty. // Central Eur. J. Urology. – 2013. – Vol. 66. – P. 440 – 444.

8. Mason B.M., Hooeing D. Carbon dioxide-based nephroscopy: a trick for laparoscopic pyelolithotomy. // J. Endourol. – 2008. – Vol. 22. – P. 2661 – 2663.

9. Schatloff O., Weintraub Y., Leibovici D. Carbon dioxide-based nephroscopy during laparoscopic pyeloplasty provides suboptimal view when stones are located in the lower calices. // J. Endourol. – 2011. – Vol. 25 (1). – P. 97 – 99.

10. Schuessler W.W., Grune M.T., Techuanhuey L.V., Preminger G.M. Laparoscopic dismembered pyeloplasty. J. Urol. 1993; 150: 1795 – 1799.

11. Davenport K., Minervini A., Timoney A.G., Keeley F.X. Our experience with retroperitoneal and transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction obstruction. // Eur. Urol. – 2005. – Vol. 48. – P. 973 – 977.

12. Singh O., Gupta S., Hastir A., Arvind N. Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: Experience with 142 cases in a highvolume center. // J. Endourol. – 2010. – Vol. 24 (9). – P. 1431 – 1434.

13. Гулиев Б.Г., Шипилов А.С. Трансперитонеальная лапароскопическая пиелопластика. Эндоскопическая хирургия. 2012; 2: 26 – 31.

14. Nadu A., Schatloff O., Morag R., Ramon J., Winkler H. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era? // J. Urol. – 2000. – Vol. 35. – P. 9 – 18.

15. Nambiralan T., Leschke S., Albqami N. et al. Role laparoscopy in management of renal stones: single-center experience and review of literature. // J. Endourol. 2005; 19: 353 – 359.

16. Desai R.A., Assimos D.G. Role of laparoscopic stone surgery. // Urology 2008; 71: 578 – 580.