title: Laparoscopic Anderson-Hynes pyeloplasty without symphysiotomy for hydronephrosis with horseshoe kidney.
abstract: BACKGROUND
  The objective of this study is to clarify whether symphysiotomy is an essential procedure combined with the laparoscopic pyeloplasty for the surgical treatment of ureteropelvic junction obstruction related to horseshoe kidney.
  
  
  METHODS
  We retrospectively reviewed five horseshoe kidney patients with symptomatic hydronephrosis who underwent laparoscopic transperitoneal Anderson-Hynes pyeloplasty without symphysiotomy between July 2002 and October 2011.
  
  
  RESULTS
  All procedures were completed successfully without open conversion. Mean operative time and estimated blood loss were 209 min and 40 mL, respectively. Anterior crossing vessels were observed in all cases, and four of them were defined as a principle cause of the obstruction. In the remaining case, intrinsic stenosis of the ureteropelvic junction was noted. Crossing vessels were transposed behind the ureter with ureteropelvic anastomosis at the anterior aspect of these structures. Preoperative symptoms were absent postoperatively in all cases. Diuretic renogram showed that renal function of the side with hydronephrosis was unchanged, but diuretic excretion half-time was diminished in all cases.
  
  
  CONCLUSIONS
  The present data suggest that symphysiotomy can be avoided in many, if not all, cases of hydronephrosis related to horseshoe kidney. Laparoscopic Anderson-Hynes pyeloplasty with transposition of anterior crossing vessels seems effective, especially if aberrant vessels are strongly suspected to be present from the preoperative imaging examination.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan. uromori2000@yahoo.co.jp
authors.forename: Morihiro
authors.initials: M
authors.lastname: Nishi
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Shinji
authors.initials: S
authors.lastname: Kurosaka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Fujita
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery*; D007682:Kidney Pelvis / Q000002:abnormalities* / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013567:Symphysiotomy; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Horseshoe kidney; laparoscopic pyeloplasty; symphysiotomy