الفهرس 
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Abstract
Pelvi-ureteric junction obstruction (PUJO) is defined as a functionally significant impairment of the flow of urine from the kidney’s renal pelvis into the proximal ureter. It is the most common congenital abnormality of the upper urinary tract which is most commonly seen in the pediatric population with an estimated incidence of 1:500 live births. In the adult population, the estimated incidence is 1:1500 The male-to-female ratio is 2:1 and the left kidney is affected twice as often as the right side. PUJO can be categorized as primary or secondary. Primary or congenital PUJO is usually due to intrinsic disease. The most common cause is an a-peristaltic segment caused by replacement of spiral musculature by longitudinal or fibrous tissue. It can be due to ureteric hypoplasia, abnormal collagen deposition leading to true stenosis, high insertion of the ureter resulting in physiological kinking. Extrinsic compression from a crossing vessel may also cause intermittent PUJO as the kidney rises and falls. This phenomenon may in part account for the observation that incidence of PUJO due to crossing vessels increase with age, as the kidney may DROP in relation to other fixed structures and result in obstruction from crossing vessels, which leads to scar tissue formation. Secondary PUJO or acquired PUJO is more common in adults and may be extrinsic or intrinsic. Acquired intrinsic strictures of the PUJ can be due to inflammation and ischemia from stones, infection or iatrogenic injuries. Fibro-epithelial polyps and urothelial tumors are other causes of intrinsic PUJO. Extrinsic etiologies of PUJO can include mass effect from malignant neoplasms or retroperitoneal fibrosis. In patients with significant recurrent loin pain , decreased renal function, frequent urinary tract infections and secondary stone formation, surgical correction of PUJO is necessary to prevent subsequent development of interstitial fibrosis and progression to chronic renal insufficiency, which is usually diagnosed by severe upper tract dilation (Grade 3/4) according to SFU grading system with increasing in renal antero-posterior diameter or decreasing in renal parenchymal thickness by ultrasound along with confounding evidence based on intravenous pyelography (IVP) and diuretic renogram scan results. Open pyeloplasty (OP) has been the gold standard for PUJO repair since the first successful reconstruction of an obstructed PUJO was accomplished in 1892 and achieves success rates exceeding 90%. Various open surgical techniques have been described based on the cause, location, and length of the PUJO. The most popular repair is the Anderson-Hynes dismembered pyeloplasty, which has universal application and is accepted as the gold standard of treatment. Open dismembered pyeloplasty originally described by Andersen et al. remains the gold standard against which new techniques must be compared. However, the morbidities associated with the flank incision such as bleeding, infection, post-operative pain, cosmosis, incisional hernia and others, has led to the development of minimally invasive approaches to UPJ repair. Over the last two decades, the treatment approach to pelvi-ureteric junction obstruction has evolved from open pyeloplasty to various minimally invasive procedures like endopyelotomy, acucise catheter incision, balloon dilatation. These minimally invasive options are reported to have been less successful than open pyeloplasty with failure rate approximately 40–60%, with most occurring within 36 monthsWith the evolution of technology, laparoscopic techniques have gained popularity in urology practice and can be performed via both transperitoneal and retroperitoneal approaches; and reported to have superior outcomes over other minimally invasive techniques. Schuessler et al. first described laparoscopic pyeloplasty (LP) in 1993, which shortly established itself as a safe and efficacious technique under expert laparoscopic hands, with a success rate of 93% to 100%, comparable to clinical outcomes of open pyeloplasty. Now, Laparoscopic dismembered pyeloplasty represents a minimally invasive alternative of gold standard open Anderson- Hynes technique that has a comparable successful outcome with open pyeloplasty while avoiding its co-morbidities. It is also better than endopylotomy as it deals effectively with the crossing vessel. Existing literature reports that (LP) has reduced the morbidity rate when compared to open pyeloplasty, with a reduction in hospital stay and less narcotic use. Therefore, versatility and assurance mark (LP) as the superior treatment modality. Few randomized control trials have been done to compare clinical outcomes of laparoscopic and open dismembered pyeloplasty. Therefore, we conducted a prospective study to assess the results between laparoscopic and open dismembered pyeloplasty at our tertiary care set-up. The current study aimed to prospectively compare the perioperative, morphological and functional outcomes on short and medium term between laparoscopic (LP) and open pyeloplasty (OP) patients. This was a prospective randomized study that was conducted at the Urology Department of Tanta University Hospitals. In the period from October 2022 to October 2023 on a total of thirty-four patients with primary PUJ obstruction. These patients were divided into 2 groups; group A (control group): At least 17 patients who underwent open pyeloplasty. group B (case group): At least 17 patients who underwent laparoscopic pyeloplasty.