Login to Access Video or Poster Abstract: MP24-07
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Introduction

Horseshoe kidneys are frequently associated with other congenital anomalies and ureteropelvic junction obstruction. Laparoscopic pyeloplasty have been successful in treating horseshoe kidneys with acceptable functional results, although study subjects are limited. We report our experience with laparoscopic management of ureteropelvic junction obstruction (UPJO) in horseshoe kidneys.

Methods

Between November 2008 and August 2016, 10 patients with symptomatic UPJO of horseshoe kidneys were underwent laparoscopic pyeloplasty. All patients presented a primary UPJO with dilatation of renal calyx system with an enlarged renal pelvis. The mean age was 32 years (range 20 to 48), and of the 6 women and 4 men, 7 (70%) presented UPJO on the left side and 3 on the left side. All patients were subject to a preoperative evaluation including renal ultrasonography, diurethic renography and intravenous urography or CT scan that revealed the presence of severe hydronephrosis. 5 (50%) had aberrant vessels. We used four ports during laparoscopic pyeloplasty. In all cases we performed dismembered pyeloplasty. After laparoscopic pyeloplasty patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams.

Results

All patients were treated laparoscopically, and no open conversions were needed. The mean operative time was 150 minutes (range 90-180 min). The mean estimated blood loss was negligible in all patients. The mean hospital stay was 3,5 days (2 - 6 d.). No intraoperative complications have occurred. A persistent UPJO was detected at first follow-up visit in one patient and was treated by transurethral endopyelotomy. A mean follow-up period was 18 months (range 8 – 84) and demonstrated a 90.0 % success rate after the initial operation.

Conclusions

Laparoscopic dismembered pyeloplasty in patients with UPJO of horseshoe kidneys is a safe and effective procedure with a high overall success rate, less morbidity and lower complication rates.

Funding

None