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VR-37
(VS)
LAPAROSCOPIC EXPLORATION FOR NEPHRECTOMY ENDED WITH DIAGNOSIS OF
MULTIPLE ANOMALIES: INCOMPLETE URETERAL TRIPLICATION AND
INTRAABDOMINAL TESTIS ASSOCIATED WITH AN ATYPICAL POLYORCHIDISM
Baran TOKAR, Cigdem ARSLAN, Surhan ARDA and Umut ALICI
Eskisehir Osmangazi University, School of Medicine, Deparment of Pediatric Surgery, Division of Pediatric Urology,
Eskisehir, TURKEY
PURPOSE
Nephrectomy is not a simple surgical procedure. One must be ready for all possible abnormalities and variations.
Triplication of the ureter is one of the rarest anomalies in the urinary tract and association with polyorchidism was not
reported yet. In this video, we present a patient having ureteral triplication and intraabdominal testis (IAT) associated
with polyorchidism.
MATERIAL AND METHODS
A left side laparoscopic nephrectomy was planned in 11 month-old boy having recurrent urinary tract infection and
nonfunctioning left kidney. He also had nonpalpable left testis.
RESULTS
Cystoscopy revealed a single left ureteric orifice at bladder neck. Laparoscopic exploration showed incomplete ureteral
triplication. A stay suture was placed to laterally located ureter; the second and then a third ureter were found. The
patient was an infant and all the neighboring structures were close to the pathology in a narrow space. A special care
was taken during dissection of the medially located ureter which is close to the main vascular structures. Following the
nephroureterectomy, kidney and ureter were removed from a mini inguinal incision. IAT was also brought out and
inguinal exploration showed another testis located in inguinal region (polyorchidism). Inguinal one was nubbin testis.
The nubbin testis had vas deferens, while normal looking IAT had only epididymis and no vas. Vas deferens of nubbin
was anastomosed to epididymis of the IAT and orchiopexy was performed.
CONCLUSIONS
Some surgically challenging anomalies may not be determined preoperatively in a nonfunctioning kidney. Laparoscopy
provides a better exposure and identifies associated anomalies in such cases.