V496 ROBOTIC UPPER POLE HEMINEPHRECTOMY FOR A CHRONICALLY OBSTRUCTED DUPLICATED COLLECTING SYSTEM IN A SOLITARY KIDNEY

Abstract

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V496 ROBOTIC UPPER POLE HEMINEPHRECTOMY FOR A CHRONICALLY OBSTRUCTED DUPLICATED COLLECTING SYSTEM IN A SOLITARY KIDNEY Wesley White, Brent Hardin, Ryan Pickens, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , Brent HardinBrent Hardin Knoxville, TN More articles by this author , Ryan PickensRyan Pickens Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complete or incomplete duplication of the ureter is one of the most common congenital malformations of the urinary tract. In some cases of complete ureteral duplication, the upper pole moiety is obstructed and non-functional while the lower pole moiety demonstrates reflux. Management of the upper pole moiety includes either upper pole heminephrectomy or reimplantation. Failure to address the upper pole ureter during lower pole reimplant can lead to recurrent obstruction and infection. METHODS A 49 year old female presented with recurrent right flank pain, fevers, and nausea. The patient had previously undergone bilateral ureteral reimplantation for vesicoureteral reflux at an outside hospital 5 years prior. Follow-up VCUG demonstrated no recurrent reflux. Cross-sectional imaging demonstrated an atrophic left kidney as well as a duplicated right kidney. A dilated right upper pole moiety was apparent. MAG3 renal scan confirmed the poorly functioning nature of the left kidney. The patient was subsequently taken to the operating room for planned robotic upper pole heminephrectomy. Following cystoscopy with retrograde pyelogram and JJ stent placement of the lower pole ureter, the colon and duodenum were reflected medially. The large upper pole ureter was immediately apparent. The obstructed ureter was dissected from the lower pole of the ureter cephalad towards the renal hilum. The obstructed system was dissected away from the lower pole collecting system and parenchyma of the kidney. The upper pole moiety was next opened and excised. The operative bed was rendered hemostatic with use of the argon beam and a topical hemostatic agent. A drain was placed and the kidney retroperitonealized. RESULTS Operative time was 134 minutes. Estimated blood loss was 25mL. There were no intraoperative or postoperative complications. Length of hospitalization was 3 days. The J-P drain and stent were removed at one week following surgery. At 8 months following surgery, the patient denies any pain or fevers. Renal function is within normal limits. CONCLUSIONS Complex upper pole heminephrectomy may be safely and efficiently addressed in a minimally invasive fashion. Use of the robotic operating platform affords improved visualization and articulation when performing hilar dissection and excision of the non-functioning moiety. Care must be taken to preserve the lower pole ureter including preoperative ureteral catheter or stent placement. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e202 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley White Knoxville, TN More articles by this author Brent Hardin Knoxville, TN More articles by this author Ryan Pickens Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...