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Die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes

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Zusammenfassung

Mit dem Vorsatz die Invasivität dieses Eingriffs zu reduzieren führten wir im August 1997 die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes in das Repertoire der Urologischen Klinik der Charité ein. Wir berichten über unsere Technik und Ergebnisse nach laparoskopischer Nierenbeckenplastik nach einem mittleren Beobachtungszeitraum von ca. 2 Jahren.

Zwischen August 1997 und September 2002 führten wir in unserer Klinik bei 52 Patienten die laparoskopische Nierenbeckenplastik nach Anderson-Hynes durch. Dabei handelte es sich in allen Fällen um eine primäre Harnstauungsniere mit entsprechender Symptomatik.

Wir bevorzugen den transperitonealen Zugang mit laterokolischer Freilegung der Niere. Nach Präparation und Darstellung von Harnleiter und Nierenbecken erfolgte in fast allen Fällen die Nierenbeckenplastik nach Anderson-Hynes mit Resektion des Nierenbeckens und neuer Anastomosierung von Harnleiter und Nierenbecken, wobei ausschließlich intrakorporal genäht und geknotet wurde.

Alle Operationen wurden erfolgreich durchgeführt. Eine Konversion zur offenen Operation war in keinem Fall notwendig. Die Operationszeit betrug im Mittel 180 min. Bei 57% der Patienten waren die Ursache der Nierenbeckenabgangsstenose aberrierende Gefäße. Postoperative Krankenhausverweildauer betrug im Median 4 Tage. Bei einem Patienten kam es postoperativ zu einer Anastomoseninsuffizienz die eine Relaparoskopie mit Übernähung erforderte. Der gleiche Patient entwickelte im weiteren Verlauf eine Restenose, die offen operativ versorgt wurde. Die Langzeiterfolgsrate beträgt bei einem mittleren Follow-up von 25 Monate 98%.

Die dargestellten Ergebnisse der laparoskopischen Nierenbeckenplastik nach Anderson-Hynes entsprechen den bekannt guten Resultaten nach offener Operation. Da jedoch die Morbidität der minimal-invasiven Technik deutlich geringer ist, verbunden mit einem besseren kosmetischen Ergebnis, glauben wir, dass die laparoskopische Nierenbeckenplastik nach Anderson-Hynes in Zukunft die Methode der Wahl in der Therapie der Nierenbeckenabgangsstenose darstellt.

Abstract

Because of the minimal invasiveness of the laparoscopic approach, we introduced the laparoscopic dismembered pyeloplasty in our treatment modalities for patients with primary UPJ obstruction. We report on our technique and the results after a median follow-up of more than 2 years.

Between August 1997 and September 2002, 52 patients underwent a laparoscopic dismembered pyeloplasty at our institution. All patients had a symptomatic primary PJ obstruction.

We prefer the transperitoneal route with laterocolic exposure of the kidney. After preparation and exposure of the ureter and the renal pelvis, we performed in each case the dismembered Anderson-Hynes pyeloplasty with resection of the pelvis and reanastomosis between the ureter and renal pelvis. Intracorporeal suturing and knotting techniques were used exclusively.

All procedures could be performed successfully. In no case was conversion to open surgery necessary. The mean operative time was 180 min. Crossing vessels were present in 57% of patients. The mean postoperative hospital stay was 4 days. The first patient had an anastomosis insufficiency, which required laparoscopic repair. The same patient failed in the follow-up. He developed a late recurrence of the stenosis and needed an open repair. In all other patients the obstruction was resolved or significantly improved. The long-term success rate is 98% with a follow-up of 25 months.

Our results with laparoscopic dismembered pyeloplasties compare favorably with those achieved by open pyeloplasties with less perioperative morbidity and discomfort. We do believe that laparoscopic dismembered pyeloplasty will be the method of choice in the treatment of UPJ obstruction.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Charité, Humboldt Universität, Berlin

    S. Deger, J. Roigas, A. Wille, M. Giessing, B. Schönberger & I. A. Türk

  2. Urologische Klinik der Charité, Humboldt Universität, Campus Mitte, Schumannstraße 20/21, 1071, Berlin

    S. Deger

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  1. S. Deger
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  2. J. Roigas
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  3. A. Wille
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  4. M. Giessing
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  6. I. A. Türk
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Correspondence to S. Deger.

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Deger, S., Roigas, J., Wille, A. et al. Die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes. Urologe [A] 42, 347–353 (2003). https://doi.org/10.1007/s00120-002-0278-z

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