title: An innovative technique of robotic-assisted/laparoscopic re-pyeloplasty in horseshoe kidney in patients with failed previous pyeloplasty for ureteropelvic junction obstruction.
abstract: To describe an innovative laparoscopic/robotic-assisted re-pyeloplasty technique in patients with recurrent ureteropelvic junction obstruction (UPJO) in horseshoe kidneys.
  
  
  
  Data from five patients (37-65, median 54 years) with symptomatic recurrence of UPJO in horseshoe kidney who underwent laparoscopic/robotic-assisted re-pyeloplasty at our institution since 2004 were evaluated retrospectively. The upper ureter together with wedge resection of the pelvis at the lower calyx was performed. The ureter is spatulated till beyond the isthmus and anastomosed to lower calyx. Rotational renal pelvis flap is used for reconstruction and conisation of the pelvis.
  
  
  
  Median operative time was 137 min (92-180) with a negligible blood loss. There was no need for conversion or revisions. Perioperative periods were uneventful. The intraoperatively inserted JJ was left for 6-8 weeks. Median postoperative differential function of affected kidney at 3 months (MAG III) was 38 % (26-42 %), unchanged from 35 % (21-41 %), preoperatively. This was stable in three patients and higher in two (5 and 7 %). There were no obstructive elements indicating anatomical ureteric obstruction. After convalescence period, three patients recurred to their work at 5 weeks, while all at 8 weeks. All patients remained asymptomatic and have not required any further interventions during whole follow-up.
  
  
  
  Described technique of laparoscopic/robotic-assisted re-pyeloplasty in horseshoe kidneys is technically feasible, safe and effective with high patient satisfaction and early convalescence. Its success rate is comparable with the results after primary pyeloplasty in horseshoe and heterotopic kidneys. Larger series may be required to allow for more accurate comparison.
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany. wael.khoder@med.uni-muenchen.de.
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany.
authors.forename: Abdulmajeed
authors.initials: A
authors.lastname: Alghamdi
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany.
authors.forename: Therese
authors.initials: T
authors.lastname: Schulz
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany.
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Becker
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University-Munich, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D000069337:Fused Kidney / Q000150:complications*; D006801:Humans; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Horseshoe kidney; Laparoscopic pyeloplasty; Pyeloplasty; Robotic-assisted pyeloplasty; Ureteropelvic junction obstruction