title: Totally laparoscopic repair of primary obstructive megaureter with pyeloplasty, complete excisional tailoring and nonrefluxing ureteral reimplantation.
abstract: OBJECTIVE
  To describe a new surgical technique of the first case of totally laparoscopic repair of primary obstructive congenital megaureter with pyeloplasty, intracorporeal excisional tailoring of the ureter and nonrefluxing ureteroneocystostomy.
  
  
  METHODS
  A 15-year-old male presented with obstructive megaureter. The standard three-port transperitoneal pyeloplasty technique and an additional 5-mm port for dynamic traction were used. Pelvic and ureteral dissection, pyeloplasty, intracorporeal excisional ureteral tailoring and nonrefluxing ureteroneocystostomy were all completed laparoscopically. A double-J stent was used to calibrate the ureter.
  
  
  RESULTS
  Operative time was 240 min. No intra and postoperative complications were observed, and there was discharge on postoperative day 2. The patient was pain-free and without urinary tract infection during the 4-month period after surgery. Follow up revealed complete resolution of the ureteral obstruction and adequate pelvic and ureteral caliber.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty, intracorporeal excisional tailoring, and non-refluxing reimplantation are safe and effective for the treatment of obstructive congenital megaureter. The totally laparoscopic approach is reproducible and provides low morbidity with inherent cosmetic advantages.
authors.affiliation: Surgery Department, Laparoscopic Section, Catarinense Institut of Urology; University of Vale do Itajaí (UNIVALI), Itajaí, Brasil; Department of Urology, European Institute of Oncology (IEO), University of Milan, Milán, Italia. Electronic address: glalmeida@ibest.com.br.
authors.forename: G L
authors.initials: GL
authors.lastname: Almeida
authors.affiliation: Surgery Department, Laparoscopic Section, Catarinense Institut of Urology; University of Vale do Itajaí (UNIVALI), Itajaí, Brasil.
authors.forename: W F S
authors.initials: WF
authors.lastname: Busato
authors.affiliation: Department of Urology, European Institute of Oncology (IEO), University of Milan, Milán, Italia.
authors.forename: O
authors.initials: O
authors.lastname: de Cobelli
mesh_terms: D000293:Adolescent; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Laparoscopia; Laparoscopy; Megaureter; Megauréter; Reimplantación ureteral; Ureteral reimplantation