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Robot-assisted Pyeloureterostomy in Bifid Renal Pelvis With Ureteropelvic Junction Obstruction of the Lower Moiety

View Article: PubMed Central - PubMed

ABSTRACT

Duplications of the urinary collecting system and pyelo-ureteral junction obstruction (PUJO) are common, but the simultaneous presence of both anomalies is rarely encountered. In incomplete duplicated systems, PUJO usually affects the lower moiety. We present the case of a 5-year old boy with left bifid renal pelvis and hydronephosis of the lower moiety treated by robot-assisted pyeloureterostomy.

No MeSH data available.


a–b Axial (a) and cornal (b) view of hydronephosis of the lower moiety. The course of the ureter draining the lower pole was not visible.
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fig1: a–b Axial (a) and cornal (b) view of hydronephosis of the lower moiety. The course of the ureter draining the lower pole was not visible.

Mentions: A 5-year-old male came to our attention for hydronephrosis of the lower pole of a left duplex kidney. He was born on term, no anomalies were prenatally identified. The left pelvic dilation was detected on a screening ultrasound at one month of age (antero-posterior diameter, APD: 12 mm). A voiding cystourethrogram ruled out a vesicoureteral reflux and other lower tract causes of hydronephrosis, such as posterior urethral valves. A diuretic renal scintigraphy with MAG3 identified a poor response to the administration of diuretic, though determining an equal contribution between the two kidneys (functional contribution 50%). Being the infant asymptomatic and parenchyma preserved, a conservative follow-up was decided. Ultrasounds were repeated every six months until the age of 3 years and then every year until the age of 5. A MAG3-diuretic renal scintigraphy was repeated at 18 months of age, and it was basically unchanged compared to the first one. The ultrasonography follow-up documented a progressive increase of the pelvic dilation (APD at 5 years, old 25 mm). An URO CT scan was performed and confirmed a left duplex kidney with a dilated lower moiety (APD 25 mm), and identified a reduction in parenchymal thickness of the lower left moiety. A tardive scan at 60°min showed a persistent retention of contrast medium within the pelvis (Fig. 1a–b).


Robot-assisted Pyeloureterostomy in Bifid Renal Pelvis With Ureteropelvic Junction Obstruction of the Lower Moiety
a–b Axial (a) and cornal (b) view of hydronephosis of the lower moiety. The course of the ureter draining the lower pole was not visible.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121166&req=5

fig1: a–b Axial (a) and cornal (b) view of hydronephosis of the lower moiety. The course of the ureter draining the lower pole was not visible.
Mentions: A 5-year-old male came to our attention for hydronephrosis of the lower pole of a left duplex kidney. He was born on term, no anomalies were prenatally identified. The left pelvic dilation was detected on a screening ultrasound at one month of age (antero-posterior diameter, APD: 12 mm). A voiding cystourethrogram ruled out a vesicoureteral reflux and other lower tract causes of hydronephrosis, such as posterior urethral valves. A diuretic renal scintigraphy with MAG3 identified a poor response to the administration of diuretic, though determining an equal contribution between the two kidneys (functional contribution 50%). Being the infant asymptomatic and parenchyma preserved, a conservative follow-up was decided. Ultrasounds were repeated every six months until the age of 3 years and then every year until the age of 5. A MAG3-diuretic renal scintigraphy was repeated at 18 months of age, and it was basically unchanged compared to the first one. The ultrasonography follow-up documented a progressive increase of the pelvic dilation (APD at 5 years, old 25 mm). An URO CT scan was performed and confirmed a left duplex kidney with a dilated lower moiety (APD 25 mm), and identified a reduction in parenchymal thickness of the lower left moiety. A tardive scan at 60°min showed a persistent retention of contrast medium within the pelvis (Fig. 1a–b).

View Article: PubMed Central - PubMed

ABSTRACT

Duplications of the urinary collecting system and pyelo-ureteral junction obstruction (PUJO) are common, but the simultaneous presence of both anomalies is rarely encountered. In incomplete duplicated systems, PUJO usually affects the lower moiety. We present the case of a 5-year old boy with left bifid renal pelvis and hydronephosis of the lower moiety treated by robot-assisted pyeloureterostomy.

No MeSH data available.