Pranjal Modi1, Rajiv Goel, S J Rizvi. 1. Department of Urology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India. dr_pranjal@yahoo.com
Abstract
BACKGROUND AND PURPOSE: Ureteropelvic junction (UPJ) obstruction can be associated with renal anomalies. We report a case of laparoscopic dismembered pyeloplasty in a lower moiety of a complete duplex system. CASE REPORT: A 40-year-old woman presented with right flank pain. Intravenous urography revealed a typical UPJ obstruction on the right side, and a diuretic renal scan showed 35% uptake of the tracer and a glomerular filtration rate of 57 mL/min with delayed excretion (T1/2 28 minutes). Transperitoneal laparoscopic dismembered pyeloplasty was performed. The operative time was 140 minutes with a blood loss of 30 mL. Diclofenac sodium (total requirement 150 mg) was used for analgesia. A diuretic renal scan at 3 months showed 41% uptake and a glomerular filtration rate of 66 mL/min, with prompt drainage without obstruction of the right kidney (T(1/2) 18 minutes). At 6 months' follow-up, the patient was symptom free. CONCLUSION: To our knowledge, our report is the third where laparoscopic pyeloplasty for a duplex system was carried out. Prior placement of Double-J stent made identification of the ureter draining the lower moiety during laparoscopic surgery much easier. The principles of open surgery could be duplicated.
BACKGROUND AND PURPOSE:Ureteropelvic junction (UPJ) obstruction can be associated with renal anomalies. We report a case of laparoscopic dismembered pyeloplasty in a lower moiety of a complete duplex system. CASE REPORT: A 40-year-old woman presented with right flank pain. Intravenous urography revealed a typical UPJ obstruction on the right side, and a diuretic renal scan showed 35% uptake of the tracer and a glomerular filtration rate of 57 mL/min with delayed excretion (T1/2 28 minutes). Transperitoneal laparoscopic dismembered pyeloplasty was performed. The operative time was 140 minutes with a blood loss of 30 mL. Diclofenac sodium (total requirement 150 mg) was used for analgesia. A diuretic renal scan at 3 months showed 41% uptake and a glomerular filtration rate of 66 mL/min, with prompt drainage without obstruction of the right kidney (T(1/2) 18 minutes). At 6 months' follow-up, the patient was symptom free. CONCLUSION: To our knowledge, our report is the third where laparoscopic pyeloplasty for a duplex system was carried out. Prior placement of Double-J stent made identification of the ureter draining the lower moiety during laparoscopic surgery much easier. The principles of open surgery could be duplicated.