1532 |

Laparoscopic Redo-Pyeloplasty Using Verti-
cal Flap Technique
Akbar Nouralizadeh, Alireza Lashay, Mohammad Hadi Radfar

Corresponding Author:

Alireza Lashay, MD 
Urology and Nephrology Research 
Center, Shahid Labbafinejad Medical 
Center, Shahid Beheshti University of 
Medical Sciences, Tehran, Iran.

Tel: +98 912 1549076
Fax: +98 22074101

E-mail: alireza_lashay@yahoo.com

Urology and Nephrology 

Research Center, Shahid Lab-

bafinejad Medical Center, 

Shahid Beheshti University of 

Medical Sciences, Tehran, Iran.

VIDEO

IINTRODUCTION

We‎have‎performed‎more‎than‎20‎laparoscopic‎pyeloplasties‎between‎2007‎and‎2012,‎here‎we‎present‎one‎of‎this‎cases.‎A‎46‎years‎old‎man‎with‎history‎of‎bilateral‎laparoscopic‎dismembered‎pyeloplasty,‎presented‎with‎left‎flank‎pain.‎
Intravenous‎urography‎(IVU)‎and‎isotope‎scan‎was‎inconclusive‎due‎to‎severe‎dilation‎of‎
pyelocalyceal‎system.‎Ureteroscopy‎revealed‎narrowing‎and‎tightening‎of‎the‎left‎uretero-
pelvic‎junction‎(UPJ)‎while‎the‎right‎UPJ‎was‎relatively‎normal.

Keywords:‎laparoscopy;‎methods;‎reconstructive‎surgical‎procedures;‎ureteral‎obstruction;‎
surgery.

SURGICAL TECHNIQUE
The‎patient‎underwent‎left‎side‎laparoscopic‎redo‎pyeloplasty‎using‎vertical‎flap‎technique.
Laparoscopic‎dissection‎through‎fibrous‎tissue‎was‎demanding,‎however‎there‎was‎no‎intra‎

Video



1533Vol. 11    |    No. 02    |     March- April 2014    |U R O LO G Y   J O U R N A L

Laparoscopic Redo-Pyeloplasty   |  Nouralizadeh et al

operative‎and‎post-operative‎complication.‎Operative‎time‎
was‎192‎minutes‎and‎intra‎operative‎blood‎loss‎was‎about‎
300‎mL.‎The‎patient‎discharged‎after‎5‎days.‎After‎6‎months‎
he‎was‎symptom‎free‎and‎the‎UPJ‎was‎patent‎in‎follow-up‎
ureteroscopy.

DISCUSSION
Laparoscopic‎ pyeloplasty‎ seems‎ to‎ be‎ the‎ new‎ standard‎
method‎for‎the‎treatment‎of‎UPJ‎obstruction‎(UPJO)‎and‎
secondary‎UPJO‎is‎increasingly‎been‎managed‎by‎laparos-
copy.(1)‎Both‎dismembered‎technique‎and‎flap‎pyeloplasty‎
have‎been‎reported‎for‎these‎special‎cases.(2-4)‎Flap‎pyelo-
plasty‎jeopardize‎tissue‎vascularity‎less‎than‎dismembered‎
technique‎therefore‎this‎technique‎may‎be‎more‎suitable‎for‎
patients‎with‎history‎of‎previous‎failed‎surgery.

CONCLUSION
Laparoscopic‎management‎of‎secondary‎UPJO‎is‎a‎feasible‎
and‎safe‎procedure‎especially‎when‎flap‎pyeloplasty‎tech-
nique‎is‎used.

CONFLICT OF INTEREST
None declared.

REFERENCES

1. Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG. Lapa-
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2. Basiri A, Behjati S, Zand S, Moghaddam SM. Laparoscopic pyelo-
plasty in secondary ureteropelvic junction obstruction after failed 
open surgery. J Endourol. 2007;21:1045-51.

3. Shadpour P, Haghighi R, Maghsoudi R, Etemedian M. Laparoscopic 

redo pyeloplasty after failed open surgery. Urol J. 2011;8:31-7.

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vage laparoscopic pyeloplasty after failed open pyeloplasty. Urol-

ogy. 2009 ;73:115-8.