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VR-2
(VS)
SUCCESSFUL TREATMENT OF RECURRENT UPJ OBSTRUCTION WITH ROBOTIC-
ASSISTED LAPAROSCOPIC NEPHROPEXY
Mohan GUNDETI, William BOYSEN and Melanie ADAMSKY
University of Chicago, Urology, Chicago, USA
PURPOSE
Repeat pyeloplasty has a high success rate for treating recurrent UPJ obstruction after failure of primary pyeloplasty, but
can sometimes be technically infeasible due to certain patients’ anatomy. We present our technique of robotic assisted-
laparoscopic (RAL) nephropexy in the pediatric population.
MATERIAL AND METHODS
In this case, our patient was a 19 year old girl who had undergone open right pyeoplasty as an infant and developed
symptomatic recurrent right UPJ obstruction.
The patient was placed in the left lateral decubitus position, and a transperitoneal approach was performed. RPG
showed abrupt narrowing at UPJ. Careful dissection of the UPJ demonstrated that the patient had an obstructing vessel
(renal hilar vessel) running over the renal pelvis, as well as an intrarenal pelvis and numerous additional accessory
vessels. As such, a dismembered pyeloplasty was not technically feasible. The kidney was then retracted laterally and
in this position the crossing vessel was no longer causing obstruction. Nephropexy was performed using three 4-0 PDS
sutures to secure the kidney to the lateral abdominal wall. At the conclusion of the procedure, the renal pelvis was free
of pressure from the accessory vessels and the UPJ was also free.
RESULTS
The procedure was uneventful without intraoperative or perioperative complication. One month postoperative
ultrasound showed grade 2 hydronephrosis postoperatively, improved from severe hydronephrosis on preoperative CT
scan. The patient's pain resolved.
CONCLUSIONS
At the time of intervention for recurrent UPJ secondary to renal vasculature, RAL nephropexy should be considered as a
viable and technically feasible treatment options among select patients.