Munich, Germany (UroToday.com) Horseshoe kidney is a rare kidney anomaly. Due to anatomical alterations, these patients often experience ureteropelvic junction obstruction (UPJO) causing further obstruction and renal function deterioration. Management of UPJO in these patients can be challenging due to anatomic abnormality. Authors performed a retrospective review of their experience of laparoscopic management of UPJO obstruction in patients with horseshoe kidneys.
Between March of 2006 and March 2015, 10 patients underwent laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction associated with horseshoe kidney. The anastomosis was performed by running or interrupted 4 -zero resorbable sutures and drained by a Double-J stent. Primary outcome was resolution of the obstruction with proper drainage and absence of pain and discomfort.
All patients underwent successful procedure with no conversion to open procedure. Mean operative time was slightly longer that in patients with normal kidney (220 minutes, range 180 to 260). Intraoperatively, it was identified that anatomical abnormalities including crossing vessels at the ureteropelvic junction was identified in 6 cases (polar vessels in 4 and renal vein in 2) and high ureteral insertion in 4.Mean hospital stay was 3,6 days (range 2 to 7). With the mean follow up of 36 months (range 4 to 108), all patients were asymptomatic with significant improvement of dilatation.
UPJO in horseshoe kidneys can pose a therapeutic dilemma. The transperitoneal laparoscopic pyeloplasty in these patients is feasible and has good success rates with low complication rates. With the current trend in robotic technology, traditional laparoscopic surgery will fade away. It is compelling to see what the results are when robotic surgery used in these patients to repair the UPJO obstruction.
Presented By:
Guliev B.
Institutition: Mechnikov Saint Petersburg State Medical Academy, Dept. of Urology, Saint-Petersburg, Russia
From the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany