V7-11: Robot Assisted Laparoscopic Pelvovesicostomy and Bladder Hitch for Ureteropelvic Junction Obstruction of a Right Pelvic Kidney With Retained Ureteral Stent
VideoIntroductions and Objectives
Ureteropelvic junction (UPJ) obstruction occurs in one third of pelvic kidneys. The majority of cases are treated with dismembered pyeloplasty. The current patient presented with the additional complication of a retained and calcified ureteral stent that was refractory to endoscopic removal. Preoperative DMSA renal scan demonstrated 21% function in the right pelvic kidney, thus definitive repair was the objective. In this video we demonstrate a case in which a 31-year-old female with a right UPJ obstruction and a retained stent in a pelvic kidney is managed by robot assisted laparoscopic pyelovesicostomy with bladder hitch to the sacral promontory.
The patient was taken to the operating room for robot assisted laparoscopic pyelovesicostomy. The operation was performed utilizing dorsal lithotomy and steep Trendelenburg positioning. After incising the retroperitoneum the right ureter was traced posterior to the fallopian tube as it entered the bladder. The right ureter was divided distal to the UPJ and the retained stent as well as a more recently placed ureteral stent were both removed. The UPJ was widely spatulated. Pyeloscopy with a flexible cystoscope was performed demonstrating minimal stone debris. The bladder was filled and tunneled posterior to the right fallopian tube. The sacral promontory was cleared and the bladder was then hitched to the presacral fascia to ensure a tension-free anastomosis. The bladder was opened transversely and a watertight anastomosis of the right renal pelvis and bladder was performed.
The patient recovered well and was discharged home on post-operative day one. She had a Foley catheter left indwelling for seven days. Post-operative CT urogram demonstrated no extravasation of urine. Renal Lasix scan at 6 weeks demonstrated excellent drainage through the right kidney and the patient continues to do well.
The treatment for UPJ obstruction in a pelvic kidney can be safely and effectively performed through a minimally invasive approach. This allowed for removal of retained stent and pelvovesicostomy utilizing a hitch to the sacral promontory in a single session.