Case report: laparoscopic pyeloplasty for ureteropelvic junction obstruction of lower moiety in duplex system.
OBJECTIVE
Ureteropelvic junction (UPJ) obstruction can be associated with renal anomalies. We report a case of laparoscopic dismembered pyeloplasty in a lower moiety of a complete duplex system.


METHODS
A 40-year-old woman presented with right flank pain. Intravenous urography revealed a typical UPJ obstruction on the right side, and a diuretic renal scan showed 35% uptake of the tracer and a glomerular filtration rate of 57 mL/min with delayed excretion (T1/2 28 minutes). Transperitoneal laparoscopic dismembered pyeloplasty was performed. The operative time was 140 minutes with a blood loss of 30 mL. Diclofenac sodium (total requirement 150 mg) was used for analgesia. A diuretic renal scan at 3 months showed 41% uptake and a glomerular filtration rate of 66 mL/min, with prompt drainage without obstruction of the right kidney (T(1/2) 18 minutes). At 6 months' follow-up, the patient was symptom free.


CONCLUSIONS
To our knowledge, our report is the third where laparoscopic pyeloplasty for a duplex system was carried out. Prior placement of Double-J stent made identification of the ureter draining the lower moiety during laparoscopic surgery much easier. The principles of open surgery could be duplicated.
Modi
Pranjal
P
Department of Urology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India. dr_pranjal@yahoo.com
Goel
Rajiv
R
Rizvi
S J
SJ
D000328:Adult; D000698:Analgesia; D003287:Contrast Media / Q000494:pharmacology; D004008:Diclofenac / Q000494:pharmacology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology*; D010535:Laparoscopy / Q000379:methods; D011877:Radionuclide Imaging; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology*; D014517:Ureteral Obstruction / Q000601:surgery*; D014567:Urography / Q000379:methods*; D013520:Urologic Surgical Procedures
D003287:Contrast Media; D004008:Diclofenac