V1084: LAPAROSCOPIC NEPHROURETERECTOMY OF A FUNCTIONAL ATROPHIC KIDNEY IN A PATIENT WITH ECTOPIC URETER WITH COMPLETE URETERIC DUPLICITY
VideoIntroduction and Objectives
Complete pyeloureteral duplication is the most frequent congenital malformation of the upper urinary tract, with an incidence of 0,9% in non selected necropsy series. A duplex kidney associated with a poorly functioning upper-pole segment is commonly associated with incontinence, voiding dysfunction, and urinary tract infections. A standard treatment option for this condition is upper-pole heminephrectomy.
We report the case of a 15 years old female who complained of mild urinary incontinence since childbirth. The CT-scan showed a bilateral ureteral duplicity, with a right functional atrophic superior kidney and an ectopic vaginal ureter. A laparoscopic resection of the superior atrophic kidney with part of the ureter was decided.
Surgery started by placing the patient in left lateral decubitus and releasing the bowel adherences. After having released the colon, both ureters were identified. The pathologic ureter was dissected proximally in order to find the vascular pedicle. This ureter crossed below the main renal vein, so by dissecting it proximally we could get access to the atrophic parenchyma. Resection of this parenchyma was performed using scissors and hem-o-locks.
After complete dissection of the atrophic kidney, by pulling from the ureter we could descend it until below the renal vein to completely release it. After that, , the distal ureter was dissected until its normal appearance was identified. It was clipped with hem-o-locks before section.
The surgical specimen was removed through one of the 12mm trocar without the need of an endobag.
Surgical time was 120min and blood loss 200cc. The patient was discharged 3 days after surgery and the pathological analysis confirmed the absence of malignancies.
Laparoscopy can be used to treat some renal malformations, with good recovery of the patient and avoiding the need of an open approach.