Acute Pyelostomy Case Studies

Between February 2012 and June 2015, three patients (2 females and one male) underwent laparoscopic repair for RCU in our department. Mean age was 36 years (range 18 - 48). All patients were symptomatic with in all cases a history of intermittent moderate right- side flank. One female patient had repeated episodes of acute pyelonephritis on the same side.

Abdominal ultrasound demonstrated right renal hydronephrosis in all patients. Urography showed medial displacement of the right JJ catheter. A computed tomography scan (CT) suspected the presence of a retrocaval ureter. Diuretic renography with 99mTc-DTPA showed significant obstruction in one patient. After informed consent, the patients had laparoscopic Pyelo-pyelostomy as described bellow.

The patient was first placed in the lithotomy position and underwent right ascending pyelography to confirm the diagnosis (typical image in the form of a hook or S-shaped (Figure 1). A right JJ catheter was then placed. After that, the patient was placed in right- side-up flank position and a transperitoneal approach was used.

The colon was reflected medially exposing the retroperitoneum. The renal pelvis and proximal ureter were identified helped by the presence of the jj catheter. The ureter was dissected and followed until the right side of the vena cava. In the interaortocaval area the ureter was identified and dissected caudally (Figure 2, 3). Using sharp and blunt dissection the retrocaval segment was then entirely mobilized and separated from the inferior vena cava (IVC). The renal pelvis was sectioned. The stent was partially withdrawn and the ureter was drawn medially from behind the vena cava. After checking the retrocaval portion was not atretic, the renal pelvis and the ureter were reanastomosed with running 4-0 polyglactin sutures in a normal anatomic