Robotic-assisted laparoscopic pyeloplasty for lower pole uretero-pelvic junction obstruction in two duplex kidneys with differing incomplete ureteral duplication



T. von Rütte*1, F.D. Birkhäuser*1, G.N. Thalmann1, P. Zehnder*1

1Urologische Universitätsklinik, Bern, Schweiz

Introduction: Ureteral duplication combined with uretero-pelvic junction obstruction (UPJO) is a rare clinical constellation,typically affecting the lower moiety.

Material and methods: One patient revealed a short (5mm), the other a long lower pole (60mm) ureteral length. Besides theoptical port, 2 robotic and a 5mm assistant trocar were used for the trans peritoneal approach. Following reflection of thedescending colon, the duplicated ureters were dissected cranially. The stenotic ureteral segments were resected and theureters spatulated over 1.5cm.In the patient with the short ureteral segment, the lower pole pyelon was reduced in size, leaving an approximately 4cm long,doubtfully vascularized proximal ureter of the upper moiety. In order to prevent ischemic complications, this ureteral segmentwas resected and an upper to lower pole uretero-pyelostomy was performed. Finally, the pyeloplasty of the lower moiety wasconfected.In the patient with the long lower pole ureteral segment, a standard pyeloplasty was performed.

Results: The renal scintigraphy at 6 months demonstrated no signs of obstruction. Both patients are free of symptoms.

Conclusion: UPJO of the lower pole of a duplex kidney can be managed successfully by minimal invasive robotic assistedsurgery. Specifically, the length of the ureteral segment between the UPJO and the ureteral junction determined thereconstructive approach.


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