Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

  • Pejman Shadpour Hasheminejad Kidney Center (HKC), Hospital Management Research Center (HMRC), Iran University of Medical Sciences (IUMS), Tehran, Iran http://orcid.org/0000-0003-4171-4168
  • H. Habib Akhyari Fellowship in Endourology; HKC, IUMS, Tehran, Iran
  • Robab Maghsoudi Assistant professor of urology; HKC, IUMS, Tehran, Iran
  • Masoud Etemadian Associate professor of urology; HKC, IUMS, Tehran, Iran
Keywords: Laparoscopy, Horseshoe kidneys, Pyeloplasty, Hellstrom, Aberrant vessels, Pyelolothitomy

Abstract

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys.

Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams.

Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90–186), and patients were discharged within 2.8 days (range: 1–6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18–120) months, the overall success rate was 93.3%.

Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient.

Author Biography

Pejman Shadpour, Hasheminejad Kidney Center (HKC), Hospital Management Research Center (HMRC), Iran University of Medical Sciences (IUMS), Tehran, Iran

Associate Professor of Urology

Founder and Director of Departments of Pediatric Urology and Laparoscopic Surgery

Iran University of Medical Sciences (IUMS)

Published
2015-11-04
How to Cite
Shadpour, P., Akhyari, H. H., Maghsoudi, R., & Etemadian, M. (2015). Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options. Canadian Urological Association Journal, 9(11-12), E775-9. https://doi.org/10.5489/cuaj.3111
Section
Original Research