V10-10: Combination of Endo-GIA with laparoscopic pyeloplasty for the treatment of a 19 year-old man of horseshoe kidney with ureteropelvic junction obstruction
The horseshoe kidney is a renal fusion anomalies which occurs in 0.25% of the population. The ureteropelvic junction obstruction (UPJO) with horseshoe kidney is uncommon. We reported that a 19 year-old man with horseshoe kidney and UPJO was underwent laparoscopic pyeloplasty and the horseshoe kidney was cut using Endo-GIA in its isthmus.
The patient presented with symptom of left flank pain with severe hydronephrosis. The diuretic renal dynamic imaging showed the complete mechanical obstruction for the upper urinary tract. The glomerular filtration rates were 34 ml/min for the left side and 40 ml/min for the right side. The computerize tomography showed the horseshoe kidney with the right-side UPJO. The ureteropelvic junction was compressed upwardly by the isthmus of horseshoe kidney. For the complete relief of the obstruction, the isthmus of the horseshoe kidney was cut using Endo-GIA combining with the laparoscopic pyeloplasty.
The surgery was done with expected post-operative results. The operative time was 125 minutes. The post-operative hospitalization was 3 days and the double-J stent was removed 3 months after surgery. The patient is asymptomatic with complete relief of obstruction.
When UPJO complicated with horseshoe kidney which may be the potential reason to cause hydronephrosis, cutting the horseshoe kidney using Endo-GIA combining with the laparoscopic pyeloplasty may be a feasible alternative.