V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES

Abstract

You have accessJournal of UrologyCME1 May 2022V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES Michael Gross, Jason Scovell, and Robert Stein Michael GrossMichael Gross More articles by this author , Jason ScovellJason Scovell More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Success rates for primary repair of a ureteropelvic junction obstruction (UPJO) are excellent, however recurrent strictures do occur in a subset of patients. Secondary UPJO presents complex and variable surgical challenges and there is no one-size-fits all solution. Ureterocalicostomy, where a healthy segment of ureter is anastomosed to a lower pole calyx, is a reasonable approach as shown in two recent patients. METHODS: Case one is a 25 year old female with a history of left UPJO who underwent primary laparoscopic pyeloplasly followed by endopyelotomy for recurrent UPJO. She additionally experienced severe gross hematuria necessitating embolization of a lower pole branch renal artery. The resulting area of ischemia and parenchymal thinning presented a particularly favorable location for ureterocalicostomy to circumvent her UPJO. This was also felt to be a more anatomic drainage pattern in an otherwise malrotated kidney. The second case is a 31 year old female with UPJO repaired with open pyeloplasty followed by robotic pyeloplasty 13 years later for secondary UPJO who presented with persistent pain and hydronephrosis. This patient was not initially planned for ureterocalicostomy, however the ureter was severely scarred to the lower pole and the more proximal tissue did not appear dissectible or suitable for a buccal mucosal graft and the decision to proceed with ureterocalicostomy was reached intraoperatively. RESULTS: Both patients recovered without complications and experienced symptomatic resolution. Beyond standard principles for dissecting the ureter in pyeloplasty, there is a role for ultrasound in these cases to identify the optimal location for the calicostomy. A nephropexy can also be utilized to reposition the kidney and decrease tension on the anastomosis. Meticulous suturing technique is necessary to ensure apposition of the mucosa to minimize scarring and failure of the repair. CONCLUSIONS: Ureterocalicostomy is a feasible option in select patients and may be an elegant solution to circumvent dense scar tissue and to take advantage of pathologic anatomy. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e54 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Gross More articles by this author Jason Scovell More articles by this author Robert Stein More articles by this author Expand All Advertisement PDF DownloadLoading ...