Robert Abouassaly1, Inderbir S Gill, Jihad H Kaouk. 1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Abstract
INTRODUCTION: Ureteral duplication is a relatively common congenital anomaly of the genitourinary tract. When symptomatic due to urinary tract infection or flank pain, the standard surgical treatment is upper pole heminephrectomy. Until relatively recently surgery involved a flank incision with significant morbidity and prolonged recovery time, especially for adult patients. We report our experience with laparoscopic upper pole partial nephrectomy (LUPPN) in adult patients with a duplicated collecting system and an obstructed, poorly functioning upper pole renal moiety. TECHNICAL CONSIDERATIONS: After reflecting the colon medially, both ipsilateral duplicated ureters are identified, with distinction between the two aided by the presence a previously positioned ureteral catheter in the lower pole ureter. The upper pole ureter is then dissected cephalad toward the renal hilum and upper pole atrophic moiety. The vascular supply to the upper pole renal moiety is meticulously dissected and controlled using vascular clips. The renal upper pole moiety is then excised along the atrophic cleavage plane using electrocautery or a harmonic scalpel. We retrospectively reviewed the medical records of 5 patients who underwent LUPPN at our institution between October 2000 and June 2005. All patients underwent the procedure without intraoperative complications. CONCLUSIONS: Laparoscopic upper pole partial nephrectomy for an obstructed upper pole moiety is a safe treatment modality with low morbidity and good outcomes.
INTRODUCTION: Ureteral duplication is a relatively common congenital anomaly of the genitourinary tract. When symptomatic due to urinary tract infection or flank pain, the standard surgical treatment is upper pole heminephrectomy. Until relatively recently surgery involved a flank incision with significant morbidity and prolonged recovery time, especially for adult patients. We report our experience with laparoscopic upper pole partial nephrectomy (LUPPN) in adult patients with a duplicated collecting system and an obstructed, poorly functioning upper pole renal moiety. TECHNICAL CONSIDERATIONS: After reflecting the colon medially, both ipsilateral duplicated ureters are identified, with distinction between the two aided by the presence a previously positioned ureteral catheter in the lower pole ureter. The upper pole ureter is then dissected cephalad toward the renal hilum and upper pole atrophic moiety. The vascular supply to the upper pole renal moiety is meticulously dissected and controlled using vascular clips. The renal upper pole moiety is then excised along the atrophic cleavage plane using electrocautery or a harmonic scalpel. We retrospectively reviewed the medical records of 5 patients who underwent LUPPN at our institution between October 2000 and June 2005. All patients underwent the procedure without intraoperative complications. CONCLUSIONS: Laparoscopic upper pole partial nephrectomy for an obstructed upper pole moiety is a safe treatment modality with low morbidity and good outcomes.