Laparoscopic repair of the ureteropelvic junction primary strictures
Polyakov N.V., Keshishev N.G., Gurbanov Sh.Sh., Grigorieva M.V., Arustamov L.D., Kazachenko A.V., Alekseev B.Ya.

Research Institute of Urology and Interventional Radiology named after O.N. Lopatkin - branch of National Medical Research Radiological Center, Moscow

Determination of indications for performing reconstructive and plastic surgeries of ureteropelvic junction (UPJ) strictures is not an easy task. Often when choosing the tactics of treatment, the anatomical and functional features of the renal unit are not taken into account, which negatively affects the effectiveness of the intervention.
The aim of the study was to evaluate the effectiveness of laparoscopic repair of UPJ strictures, depending on the anatomical and functional state of the ipsilateral kidney. 
Patients and methods: the authors analyzed the results of treatment of 134 patients who underwent various types of reconstructive operations for UPJ strictures: Group I (n = 34) - Calp de Virde flaps grafting, Group II (n = 59) - Heinz-Andersen ureteropyeloanastomosis, III group (n = 41) - antevasal ureteropyeloanastomosis. All interventions ended with the installation of an internal stent for 6-8 weeks. The effectiveness of the treatment was assessed by the following parameters: the disappearance of the pain syndrome, a decrease in the degree of pyeloectasia, stabilization or improvement of the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPJ stricture.
Results: the difference between the results of the treatment, depending on the method of operation, was unreliable (p> 0.05). A significant negative correlation was found between the efficacy of the operation and the degree of kidney function deficiency (p <0.01). The best results of treatment were noted in patients with kidney function deficiency of less than 25%. The highest percentage of ineffective interventions (66.6%) was in patients with a kidney function deficiency of more than 75%. In 75 (55.9%) patients there was a reduction in dilatation of the pelvis on the operated side in 3 months after removal of the internal stent. A significant correlation was found between the initial deficiency of kidney function and the degree of postoperative dilatation of the pelvis (p <0.05). Six patients had recurrence of UPJ stricture. The total efficacy of laparoscopic repair of UPJ was 94.7%. 
Conclusion: laparoscopic repair of UPJ is a highly effective method of surgical treatment of UPJ strictures. The degree of deficiency of kidney function should be considered the main predictive criterion for the effectiveness of the forthcoming operation.
 
Key words: UPJ strictures, laparoscopic repair of UPJ, ureteropyeloanastomosis.
For citation: Polyakov N.V., Keshishev N.G., Gurbanov Sh.Sh. et al. Laparoscopic repair of the ureteropelvic junction primary strictures // RMJ. 2017. № 8. P. 515–517.