Retroperitoneal laparoscopic management of ureteropelvic junction obstruction in patients with horseshoe kidney.

Abstract

To report our experience with retroperitoneal laparoscopic pyeloplasty for the management of ureteropelvic junction (UPJ) obstruction in patients with horseshoe kidneys (HSKs). Between March 2005 and May 2012, 2 boys, 5 men, and 1 woman (mean age, 23.9 years; range, 7-42 years) with HSKs underwent retroperitoneal laparoscopic dismembered pyeloplasties for UPJ obstructions with transections of the isthmuses. One patient had a renal calculus that was extracted during surgery. The follow-up included clinical evaluations, ultrasonography, intravenous urography, and diuretic renography. Retroperitoneal laparoscopic dismembered pyeloplasty was feasible in all cases. The median operative time was 192 minutes (range, 148-252 minutes), and there were no perioperative complications. The mean hospital stay was 5.8 days (range, 4-7 days). The mean follow-up time was 45 months (range, 18-96 months). All patients were asymptomatic and exhibited decreased pelvic dilation at follow-up. The retroperitoneal laparoscopic approach is feasible and safe for pyeloplasty in UPJ obstruction associated with HSK. Isthmectomy and a fully mobilized kidney offer better surgical exposure during the operation.