Journal Article

An innovative technique of robotic-assisted/laparoscopic re-pyeloplasty in horseshoe kidney in patients with failed previous pyeloplasty for ureteropelvic junction obstruction

Schulz, Therese, Khoder, Wael Y., Becker, Armin J., Stief, Christian G., Schlenker, Boris, Alghamdi, Abdulmajeed

2016

Overview

Objectives To describe an innovative laparoscopic/robotic-assisted re-pyeloplasty technique in patients with recurrent ureteropelvic junction obstruction (UPJO) in horseshoe kidneys. Patients and methods Data from five patients (37–65, median 54 years) with symptomatic recurrence of UPJO in horseshoe kidney who underwent laparoscopic/robotic-assisted re-pyeloplasty at our institution since 2004 were evaluated retrospectively. The upper ureter together with wedge resection of the pelvis at the lower calyx was performed. The ureter is spatulated till beyond the isthmus and anastomosed to lower calyx. Rotational renal pelvis flap is used for reconstruction and conisation of the pelvis. Results Median operative time was 137 min (92–180) with a negligible blood loss. There was no need for conversion or revisions. Perioperative periods were uneventful. The intraoperatively inserted JJ was left for 6–8 weeks. Median postoperative differential function of affected kidney at 3 months (MAG III) was 38 % (26–42 %), unchanged from 35 % (21–41 %), preoperatively. This was stable in three patients and higher in two (5 and 7 %). There were no obstructive elements indicating anatomical ureteric obstruction. After convalescence period, three patients recurred to their work at 5 weeks, while all at 8 weeks. All patients remained asymptomatic and have not required any further interventions during whole follow-up. Conclusions Described technique of laparoscopic/robotic-assisted re-pyeloplasty in horseshoe kidneys is technically feasible, safe and effective with high patient satisfaction and early convalescence. Its success rate is comparable with the results after primary pyeloplasty in horseshoe and heterotopic kidneys. Larger series may be required to allow for more accurate comparison.

• Publisher: Springer US,Springer Nature B.V
• Subject: Abdominal Surgery / Adult / Aged / Dynamic Manuscript / Female / Fused Kidney - complications / Gastroenterology / Gynecology / Hepatology / Humans / Kidney Pelvis - diagnostic imaging / Kidney Pelvis - surgery / Kidneys / Laparoscopy / Laparoscopy - methods / Male / Medicine / Medicine & Public Health / Middle Aged / Operative Time / Patient Satisfaction / Pelvis / Postoperative Period / Proctology / Reconstructive Surgical Procedures - methods / Recurrence / Retrospective Studies / Robotic surgery / Robotic Surgical Procedures - methods / Success / Surgery / Surgical Flaps / Treatment Outcome / Ureter - diagnostic imaging / Ureter - surgery / Ureteral Obstruction - complications / Ureteral Obstruction - diagnostic imaging / Ureteral Obstruction - surgery / Urography / Urologic Surgical Procedures - methods