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- Title
3D Laparoscopic Pyeloplasty in Horseshoe Kidney with Pelviureteric Junction Obstruction and Secondary Lithiasis.
- Authors
Gingu, C.; Barbu, A.; Mihancea, A.; Dick, A.; Andresanu, A.; Ianiotescu, S.; Dragan, C.; Cerempei, V.; Domnisor, L.; Sinescu, I.; Baston, C.
- Abstract
Introduction and Objectives. The most common fusion anomaly of the kidney with an incidence of approximately 1 in every 500 births is represented by the horseshoe kidney (HSK). The most common complication of HSK is kidney lithiasis. Uretero-pelvic junction obstruction (UPJO) occurs in 1 in every 1500 births, and the three conditions can be associated. The purpose of this case report is to present the 3D laparoscopic pyeloplasty as treatment for uretero-pelvic junction obstruction in horseshoe kidney and multiple renal calculi. Materials and Methods. We present the case of a 33 years old male patient, with surgical history of percutaneous nephrolithotomy 7 years prior and two ESWL procedures 1 year before, admitted for recurrent right lumbar pain. The CT scan revealed HSK with dilated right pelvi-calyceal system suggesting right UPJO and multiple secondary renal calculi. We opted for a 3D laparoscopic transperitoneal pyeloplasty and calculi extraction. The surgery was performed in a standard flank position using three ports (a 12 mm for the camera and two working trocars of 10 mm and 5 mm). After a difficult dissection due to postoperative fibrosis and vascular anomalies, the renal pelvis was suspended with a suture wire from the abdominal wall to avoid the need of an additional trocar. Then the pelvis was incised and 11 stones were removed under direct vision. We proceeded to perform a standard dismembered Anderson-Hynes pyeloplasty. A 6 Fr ureteric double-J stent was inserted in an antegrade fashion over a guidewire. The pelvi-ureteric anastomosis was performed with continuous 4-0 Vicryl suture. Results. The operative time was 90 minutes. There were no intraoperative complications or incidents encountered. The patient was discharged on the 4th postoperative day. The JJ stent was removed after 21 days. Conclusions. Although it is a high-complexity surgery due to the aberrant vessels, renal isthmus, modified anatomy of the kidney and secondary lithiasis, the 3D laparoscopic pyeloplasty could be an effective and safe procedure for treating UPJO in horseshoe kidney and secondary multiple renal calculi, even in patients with previous renal surgeries. The 3D vision system reduces the operative time as it ensures better depth perception and faster and more precise surgical gestures. In the cases of recurrent renal lithiasis UPJO should be considered and immediately managed in order to achieve long term healing.
- Subjects
KIDNEY pelvis; URETERIC obstruction; KIDNEY stones; SURGICAL complications; LAPAROSCOPIC surgery; KIDNEYS; PERCUTANEOUS nephrolithotomy
- Publication
Romanian Journal of Urology, 2019, Vol 18, Issue 3, p49
- ISSN
1223-0650
- Publication type
Article