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Totally laparoscopic ureteroneocystostomy with intracorporeal tailoring for primary obstructive megaureter.

Mitre AI, Lestingi JF, Arap MA, Lucon AM, Srougi M - Clinics (Sao Paulo) (2011)

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil. anuar@mitre.com.br

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Renal dynamic scan showed a functioning left kidney with a split function of 28%... Computed tomography scan demonstrated a marked dilation of the left pyelocaliceal system with reduced thickness of the renal parenchyma associated with a primary megaureter... The patient was initially positioned supine for intravenous access, general anesthesia, bladder catheterization and orogastric tube placement... Postoperative course was uneventful and the DTPA-99mTc... DTPA (Diethylenetriaminepentaacetic acid) radioisotopic study four months after surgery demonstrated no ureteral obstruction and an improved left renal function... The voiding cystourethrogram showed no vesico‐ureteral reflux on both sides... Although open surgery currently remains the gold standard for lower urinary tract reconstruction, all operative steps can be duplicated laparoscopically. ,, There are several techniques available for ureteral reimplantation, with success rates greater than 92%., Nevertheless, some of these procedures have not been widely accepted when done laparoscopically... In ureteral reimplantation of a primary megaureter, the ureteral diameter should be reduced from 1/5 to 1/3 of the submucosal length in order to obtain an adequate antireflux mechanism... Some authors have described a technique of extracorporeal tailoring for megaureter in order to allow laparoscopic extravesical transperitoneal antireflux ureteral reimplantation., Duplicating open techniques, we tailored the megaureter laparoscopicaly before its antireflux reimplantation... It facilitates tailoring and suturing over the plastic catheter, as well as the correct positioning of the ureter inside the submucosal tunnel before bladder anastomosis... Opening the bladder wall longitudinally down to its base facilitated the dissection of the submucosal path and avoided ureteral kinks after reimplantation... The surgery was done in an adult patient and may be considered an alternative to open surgery... It facilitated correct positioning of the neoureteral orifice inside the bladder, which is harder to reach in this population because of its pelvic situation... Its feasibility should be also confirmed in pediatric patients and greater investigation is required to evaluate long‐term efficacy.

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Computer tomography showing (A) dilated left upper urinary tract and (B) left megaureter close to the bladder.
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f1-cln_66p177: Computer tomography showing (A) dilated left upper urinary tract and (B) left megaureter close to the bladder.

Mentions: A 60‐year‐old male patient with hypertension, diabetes, dyslipidemia and chronic renal insufficiency not requiring dialysis (serum creatinine of 3,5 mg/dL) was diagnosed with severe left ureterohydronephrosis during a screening sonography. Voiding cystourethrogram revealed no vesico‐ureteral reflux. Renal dynamic scan showed a functioning left kidney with a split function of 28%. Computed tomography scan demonstrated a marked dilation of the left pyelocaliceal system with reduced thickness of the renal parenchyma associated with a primary megaureter. The right kidney was anatomically and functionally preserved (Figure 1).


Totally laparoscopic ureteroneocystostomy with intracorporeal tailoring for primary obstructive megaureter.

Mitre AI, Lestingi JF, Arap MA, Lucon AM, Srougi M - Clinics (Sao Paulo) (2011)

Computer tomography showing (A) dilated left upper urinary tract and (B) left megaureter close to the bladder.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3044588&req=5

f1-cln_66p177: Computer tomography showing (A) dilated left upper urinary tract and (B) left megaureter close to the bladder.
Mentions: A 60‐year‐old male patient with hypertension, diabetes, dyslipidemia and chronic renal insufficiency not requiring dialysis (serum creatinine of 3,5 mg/dL) was diagnosed with severe left ureterohydronephrosis during a screening sonography. Voiding cystourethrogram revealed no vesico‐ureteral reflux. Renal dynamic scan showed a functioning left kidney with a split function of 28%. Computed tomography scan demonstrated a marked dilation of the left pyelocaliceal system with reduced thickness of the renal parenchyma associated with a primary megaureter. The right kidney was anatomically and functionally preserved (Figure 1).

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil. anuar@mitre.com.br

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Renal dynamic scan showed a functioning left kidney with a split function of 28%... Computed tomography scan demonstrated a marked dilation of the left pyelocaliceal system with reduced thickness of the renal parenchyma associated with a primary megaureter... The patient was initially positioned supine for intravenous access, general anesthesia, bladder catheterization and orogastric tube placement... Postoperative course was uneventful and the DTPA-99mTc... DTPA (Diethylenetriaminepentaacetic acid) radioisotopic study four months after surgery demonstrated no ureteral obstruction and an improved left renal function... The voiding cystourethrogram showed no vesico‐ureteral reflux on both sides... Although open surgery currently remains the gold standard for lower urinary tract reconstruction, all operative steps can be duplicated laparoscopically. ,, There are several techniques available for ureteral reimplantation, with success rates greater than 92%., Nevertheless, some of these procedures have not been widely accepted when done laparoscopically... In ureteral reimplantation of a primary megaureter, the ureteral diameter should be reduced from 1/5 to 1/3 of the submucosal length in order to obtain an adequate antireflux mechanism... Some authors have described a technique of extracorporeal tailoring for megaureter in order to allow laparoscopic extravesical transperitoneal antireflux ureteral reimplantation., Duplicating open techniques, we tailored the megaureter laparoscopicaly before its antireflux reimplantation... It facilitates tailoring and suturing over the plastic catheter, as well as the correct positioning of the ureter inside the submucosal tunnel before bladder anastomosis... Opening the bladder wall longitudinally down to its base facilitated the dissection of the submucosal path and avoided ureteral kinks after reimplantation... The surgery was done in an adult patient and may be considered an alternative to open surgery... It facilitated correct positioning of the neoureteral orifice inside the bladder, which is harder to reach in this population because of its pelvic situation... Its feasibility should be also confirmed in pediatric patients and greater investigation is required to evaluate long‐term efficacy.

Show MeSH
Related in: MedlinePlus