Junction Obstruction In Horseshoe Kidney Research Articles

V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES Daniel Au, David Duchene, and Andrew Zganjar Daniel AuDaniel Au More articles by this author , David DucheneDavid Duchene More articles by this author , and Andrew ZganjarAndrew Zganjar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Horseshoe kidneys are uncommon with an estimated incidence of approximately 1 in 500 persons. Horseshoe kidneys are characterized by arrested developmental ascent and are therefore located lower in the abdomen or pelvis. They are also typically malrotated with ureters passing over the isthmus or anterior to renal parenchyma and have widely variant renal vasculature. As many as 33% will have associated ureteropelvic junction obstruction. Various approaches to horseshoe kidney pyeloplasty have been used over the decades, more recently minimally invasive robotic approaches have been utilized. Owing to the unique anatomy of horseshoe kidneys there are several technical and anatomic considerations that should be considered and which we aim to demonstrate in this video. METHODS: Using a da Vinci robotic surgical system, we performed robotic assisted laparoscopic dismembered pyeloplasty on two patients with horseshoe kidneys and left ureteropelvic junction obstruction. We recorded this case series to demonstrate technical considerations, anatomy, and technique for performing robotic assisted laparoscopic pyeloplasty for horseshoe kidneys with ureteropelvic junction obstruction. RESULTS: Robotic assisted laparoscopic pyeloplasty is a safe and effective approach to the challenging anatomy ureteropelvic junction obstruction in horseshoe kidneys pose. Robotic ports should be placed inferior and medially compared to orthotopic pyeloplasty. CONCLUSIONS: Ureteropelvic junction obstructions are common in horseshoe kidneys and these can initially present in adulthood. Horseshoe kidneys differ from orthotopic kidneys in abdominal location, orientation, and vasculature. Horseshoe kidneys can be approached trans-mesenteric or by reflecting colon and mesentery medially. Ureteropelvic junction obstructions in horseshoe kidneys are typically high inserting with ureter stretched anteriorly over renal parenchyma. The goal of reconstruction is to re-anastomose the ureter to the most dependent portion of the renal pelvis. Crossing vessels are usually not an etiology of obstruction. Symphysiotomy (division of isthmus) is generally not recommended due to increased risk of infection, fistulas, leakages, and bleeding. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e688-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Au More articles by this author David Duchene More articles by this author Andrew Zganjar More articles by this author Expand All Advertisement Loading ...

The Morphology and Treatment of Coexisting Pelvi-Ureteric Junction Obstruction In Horseshoe Kidney

The Morphology and Treatment of Coexisting Pelvi-Ureteric Junction Obstruction In Horseshoe Kidney

127 Laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys

127 Laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys

Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90-186), and patients were discharged within 2.8 days (range: 1-6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18-120) months, the overall success rate was 93.3%. To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient.

Laparoscopic Pyeloplasty in Children with Horseshoe Kidney

Laparoscopic pyeloplasty for ureteropelvic junction obstruction associated with horseshoe kidney has been described in adults but seldom in young children. We describe our experience in 10 children treated successfully with laparoscopic dismembered pyeloplasty. Eight boys and 2 girls with a mean age of 8 years (range 0.7 to 16.5) underwent laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction associated with horseshoe kidney between 2002 and 2012. Presenting symptoms were abdominal pain (3 patients), urinary tract infection (2), abdominal mass (1) and hematuria (1). Horseshoe kidney was diagnosed preoperatively in all cases but 1. The anastomosis was done by running or interrupted 5-zero or 6-zero resorbable sutures and drained by a Double-J® stent. Laparoscopic dismembered pyeloplasty was feasible in all cases. Mean operating time was 220 minutes (range 180 to 260). Anatomical abnormalities included anteriorly crossing vessels at the ureteropelvic junction in 6 cases (polar vessels in 4, ureteropelvic junction posterior to an abnormal branch of vena cava in 1 and renal vein in 1) and high ureteral insertion in 4. Two children underwent an extensive reduction pyeloplasty. Mean hospital stay was 3.2 days (range 1 to 8). Mean followup was 50 months (range 4 to 132). All patients were asymptomatic with significant improvement of dilatation. The transperitoneal laparoscopic approach is adapted for pyeloplasty in children with horseshoe kidney. This procedure allows global exploration of the upper tract and efficient identification of anatomical anomalies, especially crossing vessels. Although our series is small, it is the first known description specific to horseshoe kidney in children and demonstrates that this approach has lasting effectiveness in young children.

Laparoendoscopic Single-Site (LESS) Pyeloplasty for Horseshoe Ureteropelvic Junction Obstruction

Pyeloplasty in horseshoe kidneys can be challenging due to aberrant vasculature, renal malrotation, and ectopic location. Fewer than 20 cases of minimally invasive (MIS) pyeloplasty in horseshoe kidneys have been reported in the literature to date. We herein report the first 2 cases of laparoendoscopic single-site (LESS) pyeloplasty for UPJ obstruction in horseshoe kidneys. Two patients with symptomatic ureteropelvic junction obstruction in horseshoe kidneys were treated with an Anderson-Hynes LESS pyeloplasty. This was performed using three 5-mm trocars through a single umbilical incision, plus an accessory 3-mm port at the anterior axillary line to facilitate suturing and subsequent drain placement. Both patients had BMI <23. The operative times were 204 minutes and 171 minutes. Blood loss was negligible, and no intraoperative complications occurred. To date, 9-month renography for patient 1 demonstrates stable renal function and unobstructed drainage. After stent removal, patient 2 was asymptomatic. In experienced hands, LESS reconstructive techniques are applicable to complex renal anomalies. LESS pyeloplasty for UPJ obstruction associated with horseshoe kidneys is feasible, safe, and effective in select patients.

The minimally invasive management of ureteropelvic junction obstruction in horseshoe kidneys

Data regarding the treatment of ureteropelvic junction obstruction (UPJO) in horseshoe kidneys are limited. We performed a retrospective analysis of our experience with minimally invasive treatment of UPJO in patients with this anomaly. Between March of 1996 and March 2008, 9 patients with horseshoe kidneys were treated for UPJO at our institution. Of these patients, 6 were managed with retrograde endopyelotomy, 2 with laparoscopic pyeloplasty, and one by robotic pyeloplasty. Outcomes of these procedures were retrospectively reviewed. A total of nine patients were available for analysis. Four of six patients who underwent endopyelotomy had available follow-up, with a mean of 56months. The success rate for these patients was 75%. Two of three patients (67%) in the laparoscopic/robotic cohort were successfully treated with a mean follow-up of 21months. UPJO in horseshoe kidneys can pose a therapeutic dilemma. The minimally invasive treatment of these patients is feasible with good success rates for both endopyelotomy and laparoscopic/robotic pyeloplasty.

Robot-assisted laparoscopic pyeloplasty for the management of pelvi-ureteric junction obstruction in horseshoe kidneys: initial experience.

Minimally invasive dismembered pyeloplasty has become the gold-standard treatment for symptomatic pelvi-ureteric junction obstruction (PUJO) in recent years. A small proportion of patients with PUJO have horseshoe kidneys. We present two cases of robot-assisted pyeloplasty in horseshoe kidneys and describe the technical modifications for success in these cases. Two patients, aged 28 and 35years, were diagnosed with symptomatic PUJO in horseshoe kidneys. Both had a robotic-assisted laparoscopic dismembered pyeloplasty using the daVinci(®) surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Three-dimensional computed tomography (CT) reconstructions were performed pre-operatively to plan surgery. The transperitoneal ports were placed more caudally than usual for improved access to the PUJ. The isthmus was not divided in either case. The procedures took 190 and 90min, respectively, with minimal blood loss and no post-operative complications. Patients were discharged on post-operative day2 following catheter and drain removal. Follow-up diuretic renograms showed no residual obstruction and patients were symptomatically better. Our initial experience suggests that RALP is a safe and feasible option for the treatment of PUJO in horseshoe kidneys with good short-term outcomes. These are challenging cases and robust pre-operative planning combined with technical modifications has been beneficial to our success. The enhanced suturing possible with the daVinci(®) surgical system facilitates these procedures.

Horseshoe Kidneys: A 40-year Experience

The results presented show that horseshoe kidney is a non-fatal anomaly of renal development that can be managed successfully by standard urologic procedures. Most clinical problems are caused by hydronephrosis and renal calculi. Careful attention to the anatomy, vasculature and drainage from renal pelves at the time of operation will assure good postoperative results. The Foley Y-V pyeloplasty is a highly effective procedure for relief of ureteropelvic junction obstruction in horseshoe kidneys. As with other genitourinary anomalies the presence of a horseshoe kidney should prompt a thorough urologic evaluation.