Retroperitoneoscopic Pyeloplasty with Concomitant Neophropexy for a Ureteropelvic Junction Obstruction in Combination with Nephroptosis

Abstract

Introduction and Objectives: We herein describe our technique for retroperitoneoscopic pyelo­plasty with concomitant nephropexy in patients with a ureteropelvic junction (UPJ) obstruction in combination with nephroptosis. Methods: We performed this operation on three female patients with a right UPJ obstruction and nephroptosis diagnosed by intravenous urography, retrograde pyelography, computed tomography and an isotopic renogram. All patients underwent the insertion of a ureteral stent before laparoscopy, and they were placed in the flank position. A four-port, balloon-dissecting, retroperitoneal laparoscopic approach was used. Ge­rota’s fascia was incised and the perirenal fat was completely dissected from the kidney. A UPJ ­obstruction was identified and pyeloplasty was performed using Anderson-Hynes dismembered anastomosis. Next, kidney fixation to the abdominal wall was performed by rows of renal capsular 2-0 nylon sutures which were secured to the quadratus lumborum fascia. All procedures were performed retroperitoneoscopically. Results: The median operative time was 350 min with a range from 204 to 414 min. The median ­estimated blood loss was 50 ml with a range from 10 to 200 ml. The postoperative hospital stay was 6 days. There were no postoperative complications. The ureteral stent was removed at 6 weeks after surgery. Postoperative urography revealed a complete resolution of hydronephrosis in all cases with one complete resolution and two cases with an improvement of nephroptosis. All patients had a complete resolution of their symptoms. Conclusions: Retroperitoneoscopic pyeloplasty with concomitant nephropexy seems to be a ­feasible, effective and minimally invasive procedure for treating UPJ obstruction in combination with nephroptosis. 

Key words

pyeloplasty - nephropexy - nephroptosis

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