الفهرس 
EtiologyOnly 14 pages are availabe for public view
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Abstract
Obstruction 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.
The benefits of non-stented pyeloplasty are reduced risk of infection, avoiding the risk of developing stent syndrome, and avoiding anesthesia exposure needed for cystoscopic removal of the stent.
In our series we tried to offer the ideal solution for this debate. We tried to use fibrin glue as a sealant for anastomotic line to prevent urinary leakage and in the same time avoid the disadvantages of the ureteric stent.
We had 60 patients with primary UPJO who were divided into 2 equal groups. The first group underwent laparoscopic non-stented pyeloplasty sealed with fibrin glue and the second group underwent laparoscopic non stented pyeloplasty only.
We compared both groups as regards early postoperative data as urinary leakage, hospital stay, early postoperative complications as irritative LUTS, hematuria, and pyuria. Three months postoperative we also compared both groups as regards success which evaluated with IVP and diuretic DTPA renal scan.
After reviewing our series results we can consider sealing of the non-stented pyeloplasty repair with fibrin glue as an efficient method for UPJO carrying the same outcomes and advantages of the stented pyeloplasty, with less irritative LUTS, lower pyuria and reflux pyelonephritis caused by the stent.
On the other hand, non-stented pyeloplasty without sealing with fibrin glue has also good satisfactory results in comparison of the stented technique but in a small subset of patients we faced the disadvantage of prolonged leakage of which may necessitate a subsequent insertion of a stent.
We found that adding fibrin glue for sealing the anastomosis gives a superior effect to the outcome and it doesn’t add significant time or expense to the surgery. Due to its healing boasting properties, we recommend to use it whenever it is available.
Certainly, a larger cohort studies with longer follow-up will be required to prove the durability and safety of a stentless laparoscopic pyeloplasty, which may ultimately revolutionize previous dogmatic assertions.