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Robotic-assisted laparoscopic extravesical ureteroneocystostomy for management of adult ureteral duplication with upper pole prostatic urethral insertion.

Larson JA, Tomaszewski JJ, Smaldone MC, Jackman SV - JSLS (2009 Jul-Sep)

Bottom Line: The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra.Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement.Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. larsonja2@upmc.edu

ABSTRACT
A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed. Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement. Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

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Related in: MedlinePlus

Sagital reconstructed computed tomography images, demonstrating a left duplicated collecting system. Of note, there is a hydronephrotic upper pole with preserved renal parenchyma and a dilated ureter to the level of its ectopic insertion into the prostatic urethra.
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Figure 1: Sagital reconstructed computed tomography images, demonstrating a left duplicated collecting system. Of note, there is a hydronephrotic upper pole with preserved renal parenchyma and a dilated ureter to the level of its ectopic insertion into the prostatic urethra.

Mentions: A 55-year-old male presented with progressive obstructive urinary symptoms and was diagnosed with prostatitis by an outside urologist. Despite antibiotic and alpha-blocker therapy, his symptoms failed to improve, and he acutely presented to the emergency department with left-sided renal colic, nausea, and vomiting. A noncontrast computed tomographic (CT) scan of the abdomen and pelvis revealed a complete duplication of the left collecting system with a 7-mm distal ureteral stone obstructing the upper pole moiety. Initial attempts at retrograde endoscopic therapy were unsuccessful due to the inability to identify or access the upper pole ureter requiring acute percutaneous nephrostomy drainage. Antegrade placement of a wire identified the upper pole ureteral orifice at the level of the verumontanam, and the patient's stone was successfully treated with rigid ureteroscopy and laser lithotripsy. Three months after ureteral stent removal, the patient still reported significant lower urinary tract symptoms, and repeat imaging revealed a persistently dilated left upper pole collecting system despite resolution of his stone burden with functional upper pole renal parenchyma (Figure 1).


Robotic-assisted laparoscopic extravesical ureteroneocystostomy for management of adult ureteral duplication with upper pole prostatic urethral insertion.

Larson JA, Tomaszewski JJ, Smaldone MC, Jackman SV - JSLS (2009 Jul-Sep)

Sagital reconstructed computed tomography images, demonstrating a left duplicated collecting system. Of note, there is a hydronephrotic upper pole with preserved renal parenchyma and a dilated ureter to the level of its ectopic insertion into the prostatic urethra.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3015980&req=5

Figure 1: Sagital reconstructed computed tomography images, demonstrating a left duplicated collecting system. Of note, there is a hydronephrotic upper pole with preserved renal parenchyma and a dilated ureter to the level of its ectopic insertion into the prostatic urethra.
Mentions: A 55-year-old male presented with progressive obstructive urinary symptoms and was diagnosed with prostatitis by an outside urologist. Despite antibiotic and alpha-blocker therapy, his symptoms failed to improve, and he acutely presented to the emergency department with left-sided renal colic, nausea, and vomiting. A noncontrast computed tomographic (CT) scan of the abdomen and pelvis revealed a complete duplication of the left collecting system with a 7-mm distal ureteral stone obstructing the upper pole moiety. Initial attempts at retrograde endoscopic therapy were unsuccessful due to the inability to identify or access the upper pole ureter requiring acute percutaneous nephrostomy drainage. Antegrade placement of a wire identified the upper pole ureteral orifice at the level of the verumontanam, and the patient's stone was successfully treated with rigid ureteroscopy and laser lithotripsy. Three months after ureteral stent removal, the patient still reported significant lower urinary tract symptoms, and repeat imaging revealed a persistently dilated left upper pole collecting system despite resolution of his stone burden with functional upper pole renal parenchyma (Figure 1).

Bottom Line: The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra.Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement.Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. larsonja2@upmc.edu

ABSTRACT
A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed. Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement. Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

Show MeSH
Related in: MedlinePlus