V578 INITIAL EXPERIENCE OF TRANSVESICOSCOPIC URETERAL REIMPLANTATION WITH URETERAL PLICATION IN REFLUXING MEGAURETER

Abstract

mesenteric vessel overlying the UPJ was divided to maximize exposure of the UPJ and proximal ureter. High insertion was identified as the cause of UPJO in this case. No renal crossing vessels were found, and the isthmus was not a factor, thus was left intact. A hitch stitch is placed in the renal pelvis to elevate the UPJ. After transescting above the UPJ, the ureter is relocated to lie above the mesentery. The UPJ is excised and the ureter spatulated. 5-0 Vicryl is used for the anastomosis over a stent. RESULTS: We have performed RALP for UPJO in 4 children with horseshoe kidneys, all of whom were male, with a mean age of 4.7 years. All cases of UPJO in this cohort occurred within the left renal moiety. Mean operative time in these four cases was 120 minutes. The isthmus and renal vasculature were maintained in all cases, and there were no intraor post-op complications. All patients were dismissed within 24 hours. At mean follow-up of 9 months, all patients were radiologically and clinically improved. CONCLUSIONS: In conclusion, RALP in children with horseshoe kidneys is safe and efficacious. Meticulous intraoperative examination of the anatomy is germane to ensure aberrant crossing vessels are not overlooked. Moreover, adequate drainage can be achieved without dividing the isthmus or renal vasculature, which not only maintains blood supply to all nephrons but also avoids inherent risks associated with these maneuvers. Thus, RALP is an excellent minimallyinvasive approach for UPJO in children with horseshoe kidneys.