Laparoendoscopic single-site (LESS) pyeloplasty for horseshoe ureteropelvic junction obstruction.
OBJECTIVE
Pyeloplasty in horseshoe kidneys can be challenging due to aberrant vasculature, renal malrotation, and ectopic location. Fewer than 20 cases of minimally invasive (MIS) pyeloplasty in horseshoe kidneys have been reported in the literature to date. We  herein report the first 2 cases of laparoendoscopic single-site (LESS) pyeloplasty for UPJ obstruction in horseshoe kidneys.


METHODS
Two patients with symptomatic ureteropelvic junction obstruction in horseshoe kidneys were treated with an Anderson-Hynes LESS pyeloplasty. This  was performed using three 5-mm trocars through a single umbilical incision, plus an accessory 3-mm port at the anterior axillary line to facilitate suturing and subsequent drain placement.


RESULTS
Both patients had BMI <23. The operative times were 204 minutes and 171 minutes. Blood  loss was negligible, and no intraoperative complications occurred. To date, 9-month renography for patient 1 demonstrates stable renal function and unobstructed drainage. After stent removal, patient 2 was asymptomatic.


CONCLUSIONS
In experienced hands, LESS reconstructive techniques  are applicable to complex renal anomalies. LESS pyeloplasty for UPJ obstruction associated with horseshoe kidneys is feasible, safe, and effective in select patients.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Stephen
S
Faddegon
Yung K
YK
Tan
Ephrem O
EO
Olweny
Samuel K
SK
Park
Sara L
SL
Best
Jeffrey A
JA
Cadeddu
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011859:Radiography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D055815:Young Adult