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VR-5
(VS)
LAPAROSCOPIC URETEROCALICOSTOMY FOR URETEROPELVIC JUNCTION
OBSTRUCTION IN A CHILD
Kimihiko MORIYA, Yoko NISHIMURA, Michiko NAKAMURA, Takya KITTA, Masafumi KON, Yukiko KANNO, Hiroki CHIBA
and Nobuo SHINOHARA
Hokkaido University, Renal and Genitourinary Surgery, Sapporo, JAPAN
PURPOSE
Ureterocalicostomy has been indicated mainly in cases with failed pyeloplasty or with a completely intrarenal pelvis.
While there were several case series in adults, laparoscopic ureterocalocostomy in pediatric cases has been rarely
reported. This video demonstrates laparoscopic ureterocalicostomy in a 10-year-old girl.
MATERIAL AND METHODS
Ureteropelvic junction obstruction was identified in a 10-year- old girl. Since intrarenal pelvis and renal stone at
ureteropelvic junction was identified, laparoscopic ureterocalicostomy was indicated via transperitoneal approach. Four
ports were used, with 10-mm camera port placed at the umbilicus and 5-mm three working ports similar to laparoscopic
pyeloplasty. After exposing renal hilum and the upper ureter completely by reflecting off the ascending colon, the renal
stone was extracted without lithotripsy by making a small longitudinal incision at the ureteropelvic junction. Then, the
ureter was transected and the renal pelvis was closed by 5-0 absorbable sutures at the level of renal hilum. To make the
anostomotic site at the lower pole, a 2-cm incision was made by identifying thinning portion of the renal parenchyma at
the lower calix using ultrasound. Bleeding from incised thin renal parenchyma was minimal without clamping renal
vessels. A 5Fr double-J ureteral stent was placed in an antegrade manner followed by 3 anchor sutures using 5-0
absorbable sutures in the spatulated ureter. Ureteral-caliceal anastomosis was completed by running fashion using 5-0
absorbable suture. The operative time was 379 minutes. Blood loss was negligible and no transfusion was required.
RESULTS
Postoperative course was uneventful. The ureteral stent was removed at 8 weeks postoperatively. CT scan at 15 months
postoperatively showed marked improvement of hydronephrosis and no recurrence of renal stone.
CONCLUSIONS
Laparoscopic ureterocalicostomy would be a feasible and safe option for selected patients with complicated ureteropelvic
junction obstruction, even in the pediatric population.