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N45 Laparoscopic partial nephroureterectomy in the treatment of hydronephrosis of the upper pole of duplex kidney with megaureter

      Introduction and Objectives

      Complete duplication of the collecting system is one of the most frequent congenital defects and is detected in about 1 out of 125 (0.8%) people in the population. The uretal orifice of upper kidney in the area of muscles structures causes clenching of the distal part of ureter and inhibits the flow from the upper poles of the kidney. Then the megaureter and hydronephrosis along with the atrophy of this section develop. The best treatment in the case of upper kidney failure is partial nephroureterectomy. In the literature one may find only few examples of laparoscopic partial nephroureterectomy, mostly concerning the pediatric urology.We are presenting heminephroureterectomy laparoscopic technique as a method giving the opportunity to make a spread intervention simultaneously in the upper and lower part of the abdominal cavity without the need of changing trocars’ location.

      Material and Methods

      A 25-year-old female patient was admitted to the Department of Urology because of hydronephrosis of right duplex kidney. The patient signed an informed consent to undergo laparoscopic trasperitoneal upper-pole nephroureterectomy. The operation was carried out from the transperitoneal access using four trocars (2 × 10 mm, 2 × 5 mm) placed like in the laparoscopic transperitoneal nephrectomy. After moving the ascending colon it turned out that there was a megaureter directed toward the right accessory kidney. Continuing, a renal hilus dissected free. Pedicle was moved. It turned out that there were vessels running apart to the right accessory kidney. The vessels were clipped and cut off. Afterwards, using a harmonic knife the upper kidney was cut away from the lower one. In the second stage of the procedure the ureter was dissected free up to the intramural part of the urinary bladder. During the lower part of the abdominal cavity operation, laparoscopic tower location was changed without any changes in the location of trocars. Ureter was cut away in the lowest point after the bladder wall visualization.

      Results

      The operation was conducted without any complications, time: 215 minutes, lost of blood: 200 ml. During the first day patient remained in bed, in the second the intestinal feeding was included. In the seventh day the patient was discharged from hospital in a good general condition.

      Conclusions

      Laparoscopic partial nephroureterectomy is a method giving a possibility of minimally invasive access to the upper and lower collecting system without the necessity of opening the abdominal cavity, reducing the hospitalization time, less painful and letting a patient come back to the normal activity much faster in the comparison with the classical method.A very important advantage of this technique is good cosmetic effect which in this situation is extremely significant in case of correction of congenital defects, especially because the operation is performed mostly in children and young people.