PURPOSE: To evaluate prospectively the results obtained in 55 patients undergoing laparoscopic pyeloplasty through transperitoneal access. MATERIALS AND METHODS: From January 2005 to July 2009, fifty-five patients between 13 and 64 years old, were treated for ureteropelvic junction (UPJ) stenosis via a transperitoneal laparoscopy. All patients had clinical symptoms of high urinary obstruction and hydronephrosis confirmed by imaging methods. Anderson-Hynes dismembered pyeloplasty was performed in 51 patients and Fenger technique in the other 4 cases. Patients were clinically and imaging evaluated in the postoperative period at 3 and 6 months and then followed-up annually. RESULTS: The operative time ranged from 95 to 270 min. The mean hospital stay was 2 days. The average blood loss was 170 mL. The time to return to normal activities ranged from 10 to 28 days. Anomalous vessels were identified in 27 patients, intrinsic stenosis in 23 patients and 5 patients had high implantation of the ureter. Laparoscopic pyelolithotomy was successfully performed in 6 patients with associated renal stones. That series monitoring ranged from 1 to 55 months. One patient had longer urinary fistula (11 days), 3 patients had portal infection and 6 patients had prolonged ileus. There was one conversion due to technical difficulties. From the later postoperative complications, 2 patients had re-stenosis, one determined by Anderson-Hynes technique and the other by Fenger technique. The success rate was 95.65%. CONCLUSIONS: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

A técnica de injeção intramuscular (IM) na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente.

The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.