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Laparoscopic A nderson– H ynes pyeloplasty without symphysiotomy for hydronephrosis with horseshoe kidney
Author(s) -
Nishi Morihiro,
Iwamura Masatsugu,
Kurosaka Shinji,
Fujita Tetsuo,
Matsumoto Kazumasa,
Yoshida Kazunari
Publication year - 2013
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12038
Subject(s) - medicine , horseshoe kidney , hydronephrosis , pyeloplasty , anastomosis , ureter , surgery , stenosis , kidney , stent , urinary system , radiology
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 A nderson– H ynes pyeloplasty without symphysiotomy between J uly 2002 and O ctober 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. Conclusion The present data suggest that symphysiotomy can be avoided in many, if not all, cases of hydronephrosis related to horseshoe kidney. Laparoscopic A nderson‐ H ynes pyeloplasty with transposition of anterior crossing vessels seems effective, especially if aberrant vessels are strongly suspected to be present from the preoperative imaging examination.