Robotic Dismembered Pyeloplasty in a Horseshoe Kidney After Failed Endopyelotomy

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Abstract

We report our experience performing a robot-assisted dismembered pyeloplasty on a patient with a ureteropelvic junction obstruction in a horseshoe kidney and a prior history of endopyelotomy. We provide 18-month follow-up demonstrating that robotic pyeloplasty is a reasonable second treatment option for patients with horseshoe kidneys with failed prior endourological management.

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Most cited references 7

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The endourological management of complications associated with horseshoe kidney.

Paulos Yohannes, Arthur D. Smith (2002)

Horseshoe kidneys are the most common renal fusion anomalies. Ureteropelvic junction obstruction, urolithiasis and renal malignancies are the most common complications that occur in this patient population. Endourological management of these complications has decreased perioperative morbidity. We identified the applications of minimally invasive surgery for treating complications secondary to horseshoe kidney. A comprehensive literature review of the different endourological approaches in the management of complications secondary to horseshoe kidney was performed using MEDLINE. Ureteropelvic junction obstruction can be managed by percutaneous endopyelotomy or laparoscopic pyeloplasty with good results. Small stones associated with horseshoe kidney are best managed by shock wave lithotripsy, while stones that have failed management by shock wave lithotripsy or are greater than 2 cm. are best managed percutaneously. All patients should undergo metabolic evaluation. Ureteroscopy or shock wave lithotripsy is associated with a higher residual stone rate than the percutaneous approach. Laparoscopic nephrectomy is a safe and feasible option for benign and malignant horseshoe kidney diseases. Endourological techniques can be safe and effective for treating complications secondary to horseshoe kidney.

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Robotic-assisted laparoscopic dismembered pyeloplasty.

Vipul Patel (2005)

To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 mL. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results.

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Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies.

Pierluigi Bove, Albert M Ong, Koon Rha … (2003)

We report our experience with the laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract abnormalities. Between July 1994 and May 2002, 7 men and 4 women with upper urinary tract anatomical abnormalities were referred to our institution for management of symptomatic ureteropelvic junction obstruction. Anomalies included horseshoe kidneys in 5 cases, pelvic kidneys in 3, a pancake kidney in 1, a malrotated kidney in 1 and a duplicated collecting system in 1. Three patients had associated renal stones that were extracted during reconstruction. Mean patient age was 37.4 years (range 25 to 60). One patient had undergone a previously unsuccessful endopyelotomy and 2 had a history of abdominal surgery. Mean operative time was 195 minutes (range 85 to 403) and mean estimated blood loss was 122 cc (range 20 to 300). No patient in this series required transfusion. Average length of hospital stay was 3.2 days (range 2 to 5). Renal function failed to improve after surgery in 1 patient with poor renal function and severe hydronephrosis. The remaining 10 patients (91%) had durable clinical and/or radiographic success during a followup of 32.6 and 21.3 months, respectively. There were no major complications. Laparoscopic pyeloplasty is an effective treatment alternative for ureteropelvic junction obstruction associated with renal or urinary tract anomalies.

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Author and article information

Contributors

Mark L. Pe

Steven N. Sterious

Ji-Bin Liu

Costas D. Lallas

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Apr-Jun 2008

Volume: 12

Issue: 2

Pages: 210-212

Affiliations

Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.

Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.

Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.

Author notes

Address reprint requests to: Costas D. Lallas, MD, Department of Urology, Thomas Jefferson University, 1025 Walnut St, Ste 1112 College Building, Philadelphia, PA 19107, USA. Telephone: 215 955 6961, Fax: 215 923 1884, E-mail: costas.lallas@ 123456jefferson.edu

Article

PMC ID: 3016178

PubMed ID: 18435901

SO-VID: f1d16f4e-2860-491f-ae8f-1b0f8a5c3410

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Robotic Dismembered Pyeloplasty in a Horseshoe Kidney After Failed Endopyelotomy

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Most cited references 7

The endourological management of complications associated with horseshoe kidney.

Robotic-assisted laparoscopic dismembered pyeloplasty.

Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies.

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