title: Ureteral pseudodiverticulum associated with absorbable suture clips after laparoscopic pyeloplasty: case report.
abstract: A 48 year-old woman with pyelonephritis was found to have bilateral ureteropelvic junction (UPJ) obstruction and a nonfunctioning right kidney. She initially underwent a laparoscopic left nondismembered pyeloplasty using absorbable polydioxanone Lapra-Ty suture clips (Ethicon Endosurgery, Cincinnati, OH) to secure the anastomosis. An antegrade endopyelotomy was later necessitated. Both procedures were complicated by postoperative bacteruria and funguria. She then underwent a laparoscopic dismembered pyeloplasty, again utilizing Lapra-Ty suture clips to secure the anastomosis. Postoperatively, her course was complicated by anastomotic extravasation, bacteriuria, and funguria. Subsequently, an antegrade nephrostogram revealed a 2.5-cm diverticulum just distal to the UPJ, which contained numerous 2- to 4-mm filling defects. Nephroscopic exploration of the pseudodiverticulum revealed numerous Lapra-Ty clips, which were basket extracted. The pseudodiverticulum was fulgurated with a holmium laser. She eventually had restricturing with recurrence of the pseudodiverticulum and was treated successfully by open ureterocalicostomy.
authors.affiliation: Department of Urology, University of California, Irvine Medical Center, Orange, California 92868, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Finley
authors.forename: Elise
authors.initials: E
authors.lastname: Perer
authors.forename: Louis
authors.initials: L
authors.lastname: Eichel
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation; D020878:Device Removal; D004240:Diverticulum / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012720:Severity of Illness Index; D013525:Surgical Instruments / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods