V7-12: Robot-assisted Laparoscopic Pyeloureterostomy in Infants with Duplex Systems with Upper Pole Ureteral Obstruction: Variations in Double J Ureteral Stenting Techniques
Duplex systems can be associated with upper pole ureteral obstruction. When severe loss of function has occurred, extirpative treatment is often performed. However, if functioning renal tissue is present, urinary tract reconstruction is recommended. The expanded use of robot-assisted laparoscopic surgery has allowed the option of minimally invasive surgery for many reconstructive procedures. We describe our technique for robot-assisted laparoscopic pyeloureterostomy in infants with duplex systems with upper pole ureteral obstruction.
We applied our robot-assisted laparoscopic pyeloureterostomy technique in two female infants with right duplex systems with upper pole ureteral obstruction. Both patients were 6 - 7 months old. After the tortuous dilated upper pole ureter was dissected, the lower pole ureter was identified and the upper pole distal ureter was ligated and transected when vesicoureteral reflux was present. A Hitch stitch on the upper pole ureter or the lower pole renal pelvis allowed for better visualization for the renal pelvis incision or the pyeloureterostomy anastomosis. For the 1st case, we introduced the double J stent during the robotic operation and placed it in the recipient lower pole ureter. For the 2nd case, we inserted the double J stent during retrograde pyelography prior to the robotic procedure, and the proximal portion of the stent was placed across the anastomosis into the upper pole renal pelvis.
Postoperatively, each of the patients were discharged on postoperative day 1 without any perioperative complications. The double J stent was removed on postoperative 1 month in both patients. The postoperative renal ultrasound at 3 months demonstrated marked improvement of the right upper pole hydronephrosis in both patients.
Robotic-assisted laparoscopic pyeloureterostomy represents a minimally invasive option for upper tract reconstruction of duplex systems with upper pole ureteral obstruction even in infants. The double J ureteral stent can be placed at the beginning of or during the procedure. The ureteral stent can be placed in the lower pole ureter or across the anastomosis into the upper pole ureter.