Laparoscopic management of atypical ureteropelvic junction obstruction: alternative and simple techniques for complex situations.
OBJECTIVE
We describe novel and simple techniques for management of cases of atypical and complex ureteropelvic junction (UPJ) obstruction.


METHODS
Three cases of atypical UPJ obstruction were operated laparoscopically. Calicovesicostomy, pyelovesicostomy and ureteropyelostomy were performed laparoscopically as per the merits of each case. The 4-port technique was followed for calicovesicostomy and pyelovesicostomy (two 10-mm ports, one each at the umbilicus and lateral border of ipsilateral rectus and two 5-mm ports, one each at the lateral border of the contralateral rectus and midway between umbilicus and symphysis pubis). Both anastomoses were stented with a suprapubically placed Foley catheter. Laparoscopic ureteropyelostomy was done with port sites similar to standard laparoscopic pyeloplasty. Two double-J stents were placed, one in each moiety.


RESULTS
Mean operating time was 180 min and intraoperative blood loss was negligible. There were no intraoperative complications. The patients recovered well from the surgery. Postoperative nephrostograms confirmed anastomotic patency and good drainage. On follow-up, patients are doing well and asymptomatic. Patients with calicovesicostomy and pyelovesicostomy were advised double voiding.


CONCLUSIONS
In select cases of giant hydronephrotic kidneys, anastomosis of the bladder with the most dependent part of pelvicalyceal system ensures adequate drainage. In UPJ obstruction with ureteral duplication, ureteropyelostomy with two double-J stents can be performed with good functional results. Laparoscopic performance of these procedures is feasible and simple.
Kumar
Santosh
S
Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. santoshsp1967@yahoo.co.in
Pandya
Saurabh
S
Acharya
Naveenchandra
N
Agarwal
Mayank
M
Mandal
Arup K
AK
Singh
Shrawan K
SK
D000293:Adolescent; D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000502:physiology; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery / Q000628:therapy*; D013520:Urologic Surgical Procedures