Affiliation:
1. Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia; Regional Clinical Hospital
2. Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia
3. Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
4. Regional Clinical Hospital
Abstract
Introduction. Obstruction of the pyeloureteral junction is the most common anomaly of the upper urinary tract. Irrespective of the causes, narrowing of the ureteropelvic junction leads to abnormal urine outflux, increased intrarenal pressure, gradual sclerosis of renal parenchyma, loss of kidney function. In some cases, obstruction of the ureteropelvic junction can be accompanied by dystopic kidney, nephroptosis, abnormal location of the main and accessory renal vessels which requires correction of the standard surgical treatment.The study objective is to evaluate the effectiveness of combination of laparoscopic pyeloplasty with kidney transposition and nephropexy in obstruction of the pyeloureteral junction of a dystopic kidney.Materials and methods. Medical records of 8 patients who underwent surgery in the Kracnoyarsk Regional Clinical Hospital between 2017 and 2021 were analyzed. Obstruction of the pyeloureteral junction was confirmed clinically by ultrasound of the kidneys, excretory retrograde pyelography, contrast-enhanced spiral computed tomography.Results. In all of the 8 patients, lumbar dystopia of the affected kidney was diagnosed, in 25 % pathology was accompanied by nephroptosis, in 50 % of cases by abnormal location of the main and accessory renal vessels. All patients underwent laparoscopic plastic surgery of the pyeloureteral junction per Anderson–Hynes with antegrade ureter stenting, kidney transposition, nephropexy. Mean operative time was 190 ± 39 min, no intraoperative blood loss was observed. Ureteral catheter was removed at day (6.3 ± 2.2). Hospital length of stay was 9.3 ± 3.7 days. In 1 patient, postoperative period was complicated by suture breakage in the posterior wall of the pyeloureteral anastomosis which required repeat laparoscopy to correct suture defect. Time of ureteral stent implantation was 34.6 ± 8.5 days. Control examination showed full remission of pain syndrome. Excretory urography showed full outflow of the contrast agent after examination with furosemide in 100 % of cases.Conclusion. Combination of laparoscopic plastic surgery of the pyeloureteral segment with kidney transposition and nephropexy is an effective minimally invasive operation for treatment of ureteropelvic junction stricture of a dystopic kidney.
Publisher
Publishing House ABV Press
Subject
Urology,Reproductive Medicine,Surgery
Reference13 articles.
1. Bumbu G.A., Berechet M-K., Nacer K. et al. Clinical, surgical and morphological assessment of the pyelouretheral syndrome. Rom J Morphol Embriol 2018;59(4):1173–7. PMID: 30845298
2. Hydronephrosis, clinical recommendations. Ministry of Health of the Russian Federation, 2019. P. 8–27. (In Russ.).
3. Anderson J.C., Hynes W. Plastic operation for hydronephrosis. Proc R Soc Med 1951;44(1):4–5.
4. Schuessler W.W., Grune M.T., Tecuanhuey L.V., Preminger G.M. Laparoscopic dismembered pyeloplasty. J Urol 1993;150(6):1795–9. DOI: 10.1016/s0022-5347(17)35898-6.
5. Kavoussi L.R., Petets C.A. Laparoscopic pyeloplasty. J Urol 1993;150(6):1891–4. DOI: 10.1016/s0022-5347(17)35926.