title: Laparoscopic Pyeloplasty in children with Horseshoe Kidney.
abstract: BACKGROUND
  Horseshoe kidney occurs in 1 per 400-800 live births and are more frequently observed in males (M:F 2:1). Ureteropelvic junction obstruction (UPJO) is commonly associated with horseshoe kidneys. The variable blood supply, presence of the isthmus and high insertion of the ureter contribute to this problem.
  
  
  METHODS
  An asymptomatic 6 year-old boy presented with antenatal hydronephrosis. Ultrasonography and CT scan demonstrated left UPJO associated with a horseshoe kidney. DMSA showed 33% of function on the left side. DTPA showed a flat curve and lack of washout. A left dismembered laparoscopic pyeloplasty was performed after identification of crossing vessels and abnormal implantation of the ureter. After one year, the child is asymptomatic. DTPA demonstrated a good washout curve.
  
  
  RESULTS
  Our cohort consisted of six patients, five males and one female, with a mean age of 6 years (range 6m-17 years) and a mean follow-up of 3 years. Ureteropelvic junction obstruction was more common on the left side. Symptoms appeared only in 34% of the cases. Mean operative time was 198 minutes (range 120-270 minutes). Crossing vessels were common (observed in 50% patients). High implantation of ureter was seen in 67% patients and intrinsic obstruction in 83%. Surgical difficulties were found in two cases. Hospital stay was 4.3 days (3 to 6 days), with only one patient having a mild complication (pyelonephritis). All cases had clinical and radiologic improvement.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty is safe and feasible in children with UPJO in horseshoe kidneys, with good results and minimal morbidity.
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Paulo Renato Marcelo
authors: PR
authors: Moscardi
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Roberto Iglesias
authors: RI
authors: Lopes
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Marcos Figueiredo
authors: MF
authors: Mello
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Cristovao Machado
authors: CM
authors: Barbosa
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Bruno Nicolino
authors: BN
authors: Cezarino
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Lorena Marçalo
authors: LM
authors: Oliveira
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Francisco Tibor
authors: FT
authors: Dénes
authors: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors: Miguel
authors: M
authors: Srougi
mesh_terms: D002648:Child; D000069337:Fused Kidney / Q000601:surgery*; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods