Laparoscopic Ureterocalicostomy Research Articles

Primary laparoscopic ureterocalicostomy as an option in selected cases of ureteropelvic junction obstruction

Primary laparoscopic ureterocalicostomy as an option in selected cases of ureteropelvic junction obstruction

Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty

PurposeThis multi-institutional study aimed to assess the outcomes of laparoscopic ureterocalicostomy (LUC) and robot-assisted laparoscopic ureterocalicostomy (RALUC) and compare them with laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO).MethodsThe data of 130 patients (80 boys), with median age 7.6 years and median weight 33.8 kg, receiving minimally invasive treatment of PUJO over a 6-year period, were retrospectively analyzed. Patients were grouped according to the operative approach: G1 included 15 patients, receiving LUC (n = 9) and RALUC (n = 6), and G2 included 115 patients, receiving LP (n = 30) and RALP (n = 85). Patient characteristics and operative outcomes were compared in both groups.ResultsThe median patient age and weight were significantly higher in G1 than in G2 [p = 0.001]. The median operative time was similar in both groups (157.6 vs 150.1 min) [p = 0.66] whereas the median anastomotic time was shorter in G1 than in G2 (59.5 vs 83.1 min) [p = 0.03]. The surgical success rate was similar in both groups (100% vs 97.4%) [p = 0.33]. Post-operative complications rate was higher in G1 than in G2 (20% vs 6.1%) but all G1 complications were Clavien 2 and did not require re-intervention.ConclusionLUC/RALUC can be considered safe and effective alternative approaches to LP/RALP for PUJO repair and reported excellent outcomes as primary and salvage procedures. Robot-assisted technique was the preferred option to treat most patients with recurrent PUJO in both groups.

V01-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY AND PYELOLITHOTOMY FOR PROXIMAL URETERAL STRICTURE

You have accessJournal of UrologyCME1 May 2022V01-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY AND PYELOLITHOTOMY FOR PROXIMAL URETERAL STRICTURE Grace Lee, Hiren V. Patel, Joshua Sterling, and Sammy Elsamra Grace LeeGrace Lee More articles by this author , Hiren V. PatelHiren V. Patel More articles by this author , Joshua SterlingJoshua Sterling More articles by this author , and Sammy ElsamraSammy Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is a repair option for proximal ureteral strictures indicated in the setting of prior failed pyeloplasty, intrarenal pelvis, or significant lower pole caliectasis. In this video, we demonstrate a case of proximal ureteral stricture and recurrent nephrolithiasis, refractory to shock wave lithotripsy, treated with robotic-assisted laparoscopic ureterocalicostomy. METHODS: This procedure was performed using the da Vinci Xi robotic platform. The patient was prepped in the right lateral decubitus position and ports were placed. To begin, the bowel was mobilized, the ureter was identified, and the renal hilum was skeletonized. Next, the proximal stricture, intrarenal pelvis, and its high insertion were verified. Once the lower pole of the kidney was defatted, intraoperative ultrasonography was used to identify the location of the partial nephrectomy. After clamping the renal artery, a wedge resection of the lower pole parenchyma was performed. The parenchyma was then oversewn and the clamps were removed. At this point, a 16-French flexible cystoscope was placed through the assistant port and into the pyelotomy for stone basket extraction. The ureter was incised at the ureteropelvic junction and spatulated at the posterior aspect for 3cm. The kidney was then mobilized completely and affixed to the left psoas muscle. Next, the ureter was anastomosed to the lower calyx in a tension-free fashion and a ureteral stent was placed. The bladder was backfilled using methylene blue dyed saline and watertight seal of the anastomosis was confirmed. Finally, the anastomosis was wrapped with a Gerota’s flap. RESULTS: The procedure lasted approximately 4.5 hours without any complications. Estimated blood loss was 70cc. On postoperative day one, the drain was removed and the patient was discharged home. Postoperative computed tomography imaging revealed decreased stone burden. Six-week ureteroscopy revealed a wide-open lumen at the anastomotic site and retrograde pyelography showed no evidence of obstruction. At six months, a Lasix renogram once again demonstrated no evidence of obstruction. CONCLUSIONS: Robotic-assisted laparoscopic ureterocalicostomy is a safe and effective repair option that should be considered for proximal ureteral strictures with intrarenal pelvis and dependent lower pole calyx. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e55 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Lee More articles by this author Hiren V. Patel More articles by this author Joshua Sterling More articles by this author Sammy Elsamra More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort.

Recurrent ureteropelvic junction obstruction (UPJO) after failed pyeloplasty is a complex surgical dilemma. The robot-assisted laparoscopic ureterocalicostomy (RALUC) is a potential surgical approach, but widespread adoption is limited due to the perceived technical challenge of the procedure. We present a multi-institutional pediatric cohort undergoing RALUC for recurrent or complex UPJO, and hypothesize that the procedure is reproducible, safe and efficacious. A 3-center multi-institutional collaboration was initiated and medical records of children undergoing RALUC between 2012 and 2020 were retrospectively reviewed. The details on baseline demographics, perioperative characteristics and postoperative outcomes were aggregated. During the study period 24 patients, 7 (29%) females and 17 (71%) males, were identified. Of the patients 21 (86%) had a history of previous pyeloplasty prior to RALUC, of whom 5 (24%) had 2 prior failed ipsilateral pyeloplasties. The reason for performing RALUC was short ureter in 3 (13%), intrarenal pelvis in 5 (21%) and extensive scarring at the ureteropelvic junction locus in 16 (67%) patients. The median age of patients at time of surgery was 5.1 years (IQR: 1.9, 14.7). Of the patients 9 (38%) had percutaneous nephrostomy prior to surgery; if percutaneous nephrostomy tubes were placed for relief of obstruction, an antegrade contrast study was done postoperatively to confirm resolution of obstruction. No 30-day Clavien-Dindo Grade III-V complications were noted. During the median followup of 16.1 months (IQR: 6, 47.5), 22 (92%) had improved symptoms and hydronephrosis with no further intervention; 2 (8%) patients underwent endoscopic interventions after RALUC and both ultimately underwent nephrectomy. This multi-institutional cohort demonstrates that RALUC is a safe and efficacious salvage option for failed pyeloplasty or complex anatomy with an acceptable success profile, especially in cases of extensive scarring at the UPJO or an intrarenal pelvis.

Robotic-Assisted Laparoscopic Ureterocalicostomy for Persistent Uretero-Pelvic Junction (UPJ) Obstruction after Failed Renal Pyeloplasty

Robotic-Assisted Laparoscopic Ureterocalicostomy for Persistent Uretero-Pelvic Junction (UPJ) Obstruction after Failed Renal Pyeloplasty

V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY John Richgels, Hernan Lescay, Brittany Adamic, and Mohan Gundeti John RichgelsJohn Richgels More articles by this author , Hernan LescayHernan Lescay More articles by this author , Brittany AdamicBrittany Adamic More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is an option for renal salvage in cases where conventional reconstructions have failed or as a primary option in anatomic situations such as intrarenal pelvis, malrotated, or horseshoe kidney. The primary principle of this procedure is to allow for dependent drainage. Ureterocalicostomy is often difficult due to extensive scar tissue and may be complicated by bleeding in the setting of a normal functioning lower pole cortex.. Identification of a dependent calyx and hemostasis can be difficult when there is a normal cortical thickness. We suggest some simple tips to avoid this step and optimize surgical results. We present our experience and updated technical tips with robotic-assisted laparoscopic ureterocalicostomy and provide a step-by-step video. METHODS: Five patients underwent robotic-assisted laparoscopic ureterocalicostomy between the years 2012 and 2021 by a single surgeon. Perioperative outcomes measured included operative time, hospital stay, pain relief, degree of hydronephrosis on postoperative ultrasound at 3 months, and renal scintigraphy as needed. We describe the operative procedure and provide tips on identifying a dependent lower pole calyx, the use of harmonic scalpel for incision of the lower pole cortex, and anastomosis by pre-placement of interrupted sutures as the urothelium of the renal calyces is thin and friable. RESULTS: Four of five patients had one prior pyeloplasty, and one patient had two prior pyeloplasties. Mean operative time (incision to closure) was 208 minutes. No Clavien-Dindo 30-day complications were encountered and no patients required blood transfusion. Long term follow up was available for four out of five patients. Anatomic success was reported those four patients with a mean follow-up of 4.46 years; however, one out of the four patients with long term follow up ultimately required nephrectomy despite patent anastomosis, which would not drain due to a capacious pelvis. CONCLUSIONS: Robotic-assisted laparoscopic ureterocalicostomy is feasible in re-operative cases with extensive scaring and in patients with abnormal renal anatomy. We offer tips to allow for safe and proficient performance of this procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e690-e690 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Richgels More articles by this author Hernan Lescay More articles by this author Brittany Adamic More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement Loading ...

Crossed renal ectopia with an unusual form of fusion (inverted U shape) managed by novel approach - laparoscopic ureterocalicostomy. A case report

Herein we present a case of crossed renal ectopia with an unusual type of fusion, discovered incidentally in a 11-year-old girl presented with recurrent urinary tract infections. Both kidneys were located on the right side of the body fused in their upper poles only, forming an inverted U shape. After reviewing the published data on this topic, we found that most of the described anomalies were within the six well-known types of fusion anomalies. This child had an unusual clinical presentation of severe hydronephrosis of the orthotopic kidney. A unique surgical technique to correct the pathology to be able to preserve the residual mass of that kidney was performed.

V05-03 ROBOTIC URETEROCALICOSTOMY: TIPS AND TRICKS

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-03 ROBOTIC URETEROCALICOSTOMY: TIPS AND TRICKS Jonathan Schmidt*, James Steward, Jay Sulek, Kevin Heinsimer, and Chandru Sundaram Jonathan Schmidt*Jonathan Schmidt* More articles by this author , James StewardJames Steward More articles by this author , Jay SulekJay Sulek More articles by this author , Kevin HeinsimerKevin Heinsimer More articles by this author , and Chandru SundaramChandru Sundaram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is a well-described but rarely-performed operation for the treatment of complicated ureteropelvic junction (UPJ) strictures, particularly in the settings of a completely intrarenal pelvis, horseshoe kidney, or failed pyeloplasty. In this video, we demonstrate a robotic-assisted laparoscopic approach to this procedure, while highlighting key steps and offering recommendations on surgical technique. METHODS: A robotic-assisted laparoscopic ureterocalicostomy was performed in a 43 year old female for a complicated, symptomatic UPJ obstruction at our academic institution. Informed consent was obtained for the procedure and for the use of images and video. Preoperative workup included a retrograde pyelogram and CT urogram demonstrating a UPJ stricture, completely intrarenal pelvis, dilated lower pole calyx, and thinning lower pole parenchyma. A radionucleotide renal scan demonstrated a right split function of 42.3% and left split function of 57.7%. T1/2 max on the right was 27.1 minutes and 10.8 on the left. The da Vinci surgical system was used to perform the procedure. Each critical step of the procedure was demonstrated and narrated with a focus on surgical technique. Patient follow up was 6 months. RESULTS: We demonstrate the successful creation of the ureterocalicostomy highlighting critical steps of the operation. These include retrograde pyelogram and ureteral stent placement, kidney parenchyma and hilum exposure, ureteral exposure and transection, closure of the UPJ, clamping, excision of the lower pole of the kidney, and the uretero-calyceal anastomosis. The stent was removed at 1 month. At 3 months a renal ultrasound demonstrated lower pole calcyceal enlargement but overall resolved hydronephrosis. The patient reported resolution of pain at 6 months. CONCLUSIONS: This video demonstrates the utility and feasibility of a minimally-invasive ureterocalicostomy for the adult patient and provides detailed recommendations on surgical technique. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e470-e470 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Schmidt* More articles by this author James Steward More articles by this author Jay Sulek More articles by this author Kevin Heinsimer More articles by this author Chandru Sundaram More articles by this author Expand All Advertisement PDF downloadLoading ...

Laparoscopic ureterocalicostomy in children: The technique and feasibility

Ureterocalicostomy is a salvage technique commonly used for failed pyeloplasties; it has also been reported as a primary procedure in ureteropelvic junction obstruction (UPJO). This video describes the technique of laparoscopic ureterocalicostomy for primary UPJO in a child with a malrotated kidney and parenchymal thinning. A 13-year-old girl with symptomatic UPJO was found to have a malrotated kidney with a high posterior insertion of the ureter. A laparoscopic dependent ureterocalicostomy over a double-J stent was performed. The postoperative course was uneventful, with excellent clinical and radiological outcomes. Literature review revealed only two reports of this laparoscopic procedure as a primary surgery in children (one with intrarenal pelvis associated to urolithiasis and the other with a malrotated kidney). Laparoscopic ureterocalicostomy is a safe and feasible option in selected cases with parenchymal thinning due to atypical UPJ anatomy or failed pyeloplasty.

Laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in a 10-year-old female patient: a case report

BackgroundUreterocalicostomy is indicated mainly in cases with failed pyeloplasty or with a completely intrarenal pelvis. While there have been several case series reported in adults, laparoscopic ureterocalicostomy in pediatric cases has rarely been reported. We report a case of pure laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in an Asian female child.Case presentationA 10-year-old female patient was referred to our hospital due to right high-grade hydronephrosis and a right renal stone, which was detected due to hematuria. Laparoscopic pyelolithotomy and ureterocalicostomy were indicated because of the completely intrarenal pelvis with thinning of the cortex, especially at the lower calyx. A transperitoneal approach was implemented in a lateral flank position with four trocars. After exposing the renal hilum, the renal stone was extracted without lithotripsy by making a small longitudinal incision at the ureteropelvic junction. Then, the ureter was transected, and the renal pelvis was closed. A 2-cm incision was made at the lower calyx. Uretero-caliceal anastomosis was completed in a running fashion using 5-0 absorbable sutures. The operation time was 379 min. The postoperative course was uneventful. Postoperative imaging studies showed marked improvement of the right hydronephrosis.ConclusionLaparoscopic ureterocalicostomy is a safe and feasible treatment for selected patients with complicated ureteropelvic junction obstruction, even in the pediatric population.

Ureterocalicostomy for Reconstruction of Complicated Ureteropelvic Junction Obstruction in Adults: Long-Term Outcome and Factors Predicting Failure in a Contemporary Cohort

Ureterocalicostomy is a well established treatment option in patients who have recurrent ureteropelvic junction obstruction with postoperative fibrosis and a relatively inaccessible renal pelvis. We evaluated the long-term outcome of ureterocalicostomy and factors predicting its failure. We retrospectively analyzed data on 72 patients who underwent open or laparoscopic ureterocalicostomy from 2000 to 2014. Variables that may affect the outcomes of ureterocalicostomy were assessed with regard to primary pathology findings, patient age, serum creatinine, preoperative renal size (less than and greater than 15 cm), renal cortical thickness (less than and greater than 5 mm), hydronephrosis grade and preoperative renal function (glomerular filtration rate less than and greater than 20 ml/minute/1.73 m2). The surgery outcome was calculated in terms of success or failure. Factors predicting failure were evaluated by univariate and multivariate analysis. Failure was defined as an additional procedure required postoperatively due to persistent symptoms and/or followup renal scan showing persistent significant obstruction with deterioration of renal function on at least 2 occasions 3 months apart. Patients with less than 2-year followup were excluded from study. We analyzed data on 72 patients who underwent ureterocalicostomy during this period. Mean ± SD age of the study group was 28.9 ± 12.3 years and mean baseline serum creatinine was 1.1 ± 0.3 mg/dl. The mean glomerular filtration rate was 27.8 ± 11.6 ml/minute/1.73 m2 and mean cortical thickness of the operated kidney was 7 ± 3.86 mm. Common indications for ureterocalicostomy were failed previous pyeloplasty and/or endopyelotomy in 35 patients (48.6%) and secondary ureteropelvic junction obstruction after pyelolithotomy or percutaneous nephrolithotomy in 24 (33.3%). The most common complication was urinary tract infection, which was seen in 22 patients (30.6%). At a mean followup of 60.3 ± 13.6 months 50 patients (69.5%) had a successful outcome. Treatment failed in 22 patients (30.5%), including 6 who required nephrectomy, while 13 were treated with frequent changes of Double-J® stents or with balloon dilation. In 3 patients ureterocalicostomy was repeated. The rate of failed ureterocalicostomy was higher in patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2), attenuated cortical thickness (less than 5 mm) and higher creatinine (greater than 1.7 mg/dl) on univariate analysis. However, on multivariate analysis poor cortical thickness and a low glomerular filtration rate were independent predictors of failure. Ureterocalicostomy is an acceptable salvage option with a satisfactory long-term outcome. Patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2) and a thinned out cortex (less than 5 mm) showed a poor outcome after ureterocalicostomy.

LAPAROSCOPIC URETEROCALICOSTOMY IN EXTENT RECURRENT STRICTURE OF RIGTH URETEROPELVIC JUNCTION

The article presents the result of laparoscopic ureterocalicostomy. We observed the patient 39 y. who was admitted with complaints of aching pain in right lumbar part. 10 years ago he was underwent open pyeloplasty. In 2017 again there were pain in right kidney. At examination on CT with intravenous urography is revealed extended stricture of ureteropelvic junction, intrarenal pelvis, dilated pelvi-caliceal system and thin parenchyma under lower calyx. In flank position using transperitoneal approach we mobilized upper third of right ureter, transected distally of stricture and performed anastomosis with lower calyx. Operative time 110 min, bloodloss – 50 ml. No intra- and postoperative complications. Drain removed in 2 days, nephrostomic drain – in 7 days. Stent removed after 6 weeks. In a follow-up survey the patient haven’t any complaints, and a moderate expansion of the renal pelvicaliceal system on ultrasound.

Laparoscopic ureterocalicostomy in pigs - experimental study

This study aimed to evaluated laparoscopic ureterocalicostomy as treatment of experimental ureteropelvic junction (UPJ) obstruction in pigs. Ten male Large White pigs weighting approximately 28.4 (±1.43) kg were used in the current study. The UPJ obstruction was created laparoscopically by double-clipping of the left ureter. After 14 days the animals underwent laparoscopic ureterocalicostomy f The animals were sacrificed for subsequent retrograde pyelography in order to assess the anastomotic patency on the 28th day. The laparoscopic procedure for experimental obstruction of UPJ was successfully performed in all animals, as well as the laparoscopic ureterocalicostomy. There was intestinal iatrogenic injury in one animal. Satisfactory UPJ patency was noted in 75% of the animals. There was no stenosis of the proximal anastomosis between the ureter and the lower pole of the kidney in 37.5%, mild stenosis in 37.5% and severe stenosis in 25% of the animals. The laparoscopic approach for reestablishment he urinary flow by ureterocalicostomy was feasible in the porcine model. The ascending pyelography revealed satisfactory results of the laparoscopic ureterocalicostomy

V7-09 ROBOT-ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY IN THE PEDIATRIC PATIENT

You have accessJournal of UrologyPediatrics1 Apr 2015V7-09 ROBOT-ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY IN THE PEDIATRIC PATIENT Ashley Wietsma, Patricia Cho, and Richard Yu Ashley WietsmaAshley Wietsma More articles by this author , Patricia ChoPatricia Cho More articles by this author , and Richard YuRichard Yu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1940AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureterocalicostomy is a versatile alternative to the traditional Anderson-Hynes pyeloplasty in the treatment of recurrent ureteropelvic junction (UPJ) obstruction, UPJ obstruction associated with anatomic anomalies, such as horseshoe kidney and intrarenal pelvis, and trauma of the UPJ or proximal ureter. Although the robotic approach has become increasingly popular for urologic reconstructive procedures in the adult and pediatric populations, little data has been published on robot-assisted laparoscopic ureterocalicostomy especially in the pediatric population. To illustrate the feasibility of this minimally invasive approach in pediatrics, we present a case series with one representative video of robotic ureterocalicostomy. METHODS Four patients with an age range of 11 to 22 years (average age 15 years) with equal gender distribution underwent robot-assisted laparoscopic ureterocalicostomy for left UPJ obstruction between 2011 and 2014. In all patients, preoperative ultrasound revealed severe hydronephrosis with diffuse cortical thinning. Preoperative renal scans (MAG3 or DMSA) demonstrated decreased differential renal function on the affected left side in a range of 29-40% (average 31%), and obstructive parameters with a diuretic half-time in the range of 19 to greater than 100 minutes (average time 51 minutes). Half of the patients underwent planned, salvage ureterocalicostomy reconstruction due to recurrent UPJ obstruction following traditional pyeloplasties. Utererocalicostomy was indicated as a primary procedure for the other two patients due to anatomic abnormalities, an intrarenal pelvis and complex ureteral anatomy. RESULTS There were no intraoperative complications. Double-J ureteral stents were placed intraoperatively in each patient. Mean hospital stay was 1.5 days. Stents were removed less than 7 weeks postoperatively. Postoperative ultrasound demonstrated persistent, but stable hydronephrosis, an unsurprising result given their history of long-standing obstruction and severe hydronephrosis. Two patients experienced recurrent flank pain, but renography revealed a widely patent anastomosis. CONCLUSIONS Robotic ureterocalicostomy is a feasible and successful procedure for recurrent and severe UPJ obstruction in pediatric patients. Its versatility allows for its application for both pyeloplasty failure and as an alternative procedure for cases of challenging renal and ureteral anatomy. More data is necessary to quantify the advantages and disadvantages of the robotic approach as compared to open and laparoscopic approaches. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e661-e662 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Wietsma More articles by this author Patricia Cho More articles by this author Richard Yu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic ureterocalicostomy for complicated upper urinary tract obstruction: mid-term follow-up

To report on the largest series of laparoscopic ureterocalicostomies done for complicated upper urinary obstruction. We retrospectively reviewed the data from 6 transperitoneal laparoscopic ureterocalicostomies performed in our institution from January 2008 to January 2012. Symptomatic complicated upper urinary obstruction was the main reason for all the procedures. The recorded data included age, gender, clinical presentation, duration of symptoms, laterality, mean operative time, hospital stay, complications and clinical and functional outcomes. The median patient age was 20.1 (2-44) years, and all patients were females. Patients underwent laparoscopic ureterocalicostomy due to previous failed procedures (3 patients), anatomic abnormalities (2 patients) and a severe upper ureteral stenosis (1 patient). The median operative time was 215 (180-270) min. There were no major complications. There were no conversions to open surgery. In a median follow-up of 30 (8-56) months, all patients presented with clinical and radiological improvement with no signs of obstruction. In all cases, the postoperative renal scintigraphy revealed a T1/2 lower than 10 min. Laparoscopic ureterocalicostomy is feasible and associated with high success rate in well-selected cases with complicated upper urinary obstructions.

Technique of Laparoscopic Ureterocalicostomy in a Pediatric Patient

Purpose To present a video demonstrating the technical details of a successful laparoscopic ureterocalicostomy in a pediatric patient. Material and Methods Pyeloplasty is the contemporary definitive surgical management of ureteropelvic junction (UPJ) obstruction. However, under certain circumstances such as a small intrarenal pelvis, extremely thinned parenchyma, and/or failed pyeloplasty, ureterocalicostomy may be utilized as an alternative surgical option for reconstruction. There have been only a handful of reports of laparoscopic ureterocalicostomy in the adult population. To our knowledge, there are no reports of standard laparoscopic ureterocalicostomy in children. The patient is 13-year-old female who was scheduled for a transabdominal laparoscopic pyeloplasty to treat symptomatic UPJ obstruction. During the procedure she was found to have a high insertion of the UPJ as well as multiple lower pole crossing vessels, compromising access to the obstruction for reconstruction with a traditional pyeloplasty. Ureterocalicostomy was felt to be a safer option for this patient. The video demonstrates the technique of a primary laparoscopic ureterocalicostomy in this patient utilizing a 5mm camera port and two 3mm working ports. Results The patient was discharged home in stable condition on postoperative day one with a ureteral stent in place, tolerating a regular diet, ambulating, and pain free. Follow-up ultrasound at 8 months showed near total resolution of severe hydronephrosis. She remains asymptomatic and free of complications with 2-year follow-up. Conclusions Laparoscopic transabdominal ureterocalicostomy can be performed safely and effectively in the pediatric population.

Case Report: Robotic-Assisted Laparoscopic Ureterocalicostomy with Long-Term Follow-Up

Robotic-assisted laparoscopic surgery is being applied to a growing number of procedures. A 32-year-old woman with ureteropelvic obstruction underwent a robotic-assisted laparoscopic ureterocalicostomy in 2005. She had an uncomplicated surgery with minimal blood loss and post-operative course. Imaging done serially after surgery remained stable. She became pregnant about 2 years later and ultimately required percutaneous nephrostomy for flank pain and worsening hydronephrosis in the third trimester. Nephrostogram after delivery showed a patent anastomosis, and the nephrostomy tube was removed. Robotic-assisted laparoscopy is an option for patients who require ureterocalicostomy. Long-term outcome at 3 years is favorable.

Laparoscopic Ureterocalicostomy: A Reliable Last Resource

Background: The operative technique of laparoscopic ureterocalicostomy for significant ureteropelvic junction fibrosis associated with previous stone disease treatment is reported. Patients and Methods: Three female patients (mean age 32 years, range 25–38 years) presented with complications of urolithiasis treatment between 2003 and 2005. Significant pyeloureteral fibrosis was verified in all patients. A laparoscopic ureterocalicostomy to manage such defects was performed. Follow-up included clinical evaluation, nuclear renography, intravenous urography and serum chemistry. Results: The procedure was transperitoneally performed with a 4-port technique. Vascular control of the renal hilum was indicated in 2 cases (cases 1 and 3) with a mean warm ischemia time of 29 min (range 25–32 min). Mean operative time was 150 min (range 90–210 min) and mean blood loss was 550 ml (range 100–1,000 ml). Operations were performed in the left renal unit in all cases. Post-operative pyelograms verified adequate renal unit excretion. No significant variations on pre- and post-operative serum chemistry were verified. At a mean follow-up period of 26 months (range 12–32 months), there was no evidence of renal function loss which was demonstrated by nuclear renography. Conclusion: In experienced hands a difficult procedure such as ureterocalicostomy can be performed by laparoscopy. This is a complex procedure that is indicated in selected cases where the stenosis of the pyeloureteral junction is associated with an intra-renal pelvis. In our experience results are comparable with those previously reported in open surgery.

Robotic Ureterocalicostomy in the Pediatric Population

Ureterocalicostomy is a potential option in patients with ureteropelvic junction obstruction and significant lower pole calicectasis. It is often reserved for patients with a failed pyeloplasty and a minimal pelvis, or patients with an exaggerated intrarenal pelvis. We present our technique of robotic ureterocalicostomy in the pediatric population as a primary modality for an exaggerated intrarenal collecting system not amenable to standard dismembered pyeloplasty, and for secondary ureteropelvic junction obstruction. Nine patients 3 to 15 years old (mean age 6.5) underwent transperitoneal robotic ureterocalicostomy for ureteropelvic junction obstruction. Six of the patients had recurrent ureteropelvic junction obstruction after primary pyeloplasty performed elsewhere. The remaining 3 patients had an exaggerated intrarenal collecting system with minimal or no appreciable renal pelvis for reconstruction. Outcome measures included operative time, length of hospital stay and postoperative ultrasound at 3 months, as well as resolution of obstruction by diuretic radionuclide imaging at 6 and 12 months of followup. Mean operative time was 168 minutes (range 102 to 204) for the ureterocalicostomy portion. Two patients underwent concomitant pyelolithotomy, with 14 and 21 minutes added to the operative time. Mean hospital stay was 21 hours (range 17 to 26). Diuretic radionuclide imaging, which was performed in all patients at 6 and 12 months postoperatively, revealed no evidence of obstruction in any patient. Robotic ureterocalicostomy is a viable and technically feasible treatment option for patients with recurrent ureteropelvic junction obstruction, or patients with difficult intrarenal ureteropelvic junctions.

Laparoscopic Ureterocalicostomy for Salvage of Giant Hydronephrotic Kidney: Initial Experience

Reconstructive surgery for salvage of giant hydronephrosis is associated with unique challenges. We introduce the surgical technique of laparoscopic ureterocalicostomy for giant hydronephrosis. A transperitoneal five-port access was created and, after reflecting the colon, the lower pole of the hydronephrotic sac was excised. A wide, spatulated end-to-end ureterocaliceal anastomosis was performed. The sac was decompressed slowly in a controlled manner, which helped during dissection. At 3 months of follow-up, the patient was symptom free, and retrograde ureterography showed a wide, patent anastomosis. Laparoscopic ureterocalicostomy is technically feasible for the salvage of a giant hydronephrotic kidney and duplicates the results of open surgery.