雙套腎併嚴重腎水腫行後腹腔輸尿管吻合術治療：病例報告與文獻回顧

王煥凱、曾文歆

奇美醫學中心 外科部 泌尿科

Retroperitoneal laparoscopic ureteroureterostomy for the severe hydroureteronephrosis of the upper moiety in a complete duplicated collecting system: case report and literature review

Huan-Kai Wang, Wen-Hsin Tseng

Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Introduction:

  The most common renal anomalies are duplication of the collecting system with incidence of 0.8%. Laparoscopic pyeloplasty is gaining more popular as the recent development of laparoscopic approaches. Though this technique was difficult and need for intracorporeal knot tying. However, increasing experience has gradually identified laparoscopic pyeloplasty as the optimum procedure since it combines success rates similar to that of open surgery with the low morbidity of laparoscopic approaches. We report a case of laparoscopic pyeloplasty in an incompletely duplicated collecting system with severe hydroureteronephrosis and atrophy of the upper moiety.

Case presentation:

  The patient, a 67-year-old woman, presented with intermittent left flank pain for several months. The pain would excerbated by cough and deep breath. Abdominal computed tomography revealed complete duplication of the left kidney with ectopic ureteral insertion into the vagina and a 0.5cm stone impaction at the outlet causing severe hydroureteronephrosis and atrophy of the upper moiety. After extensive counseling and discussion of the various therapeutic options and likely outcomes with the patient, laparoscopic pyeloplasty was chosen. The operation took 190 minutes and blood loss was 100 ml. The drain was decreased on the postoperative second day and was removed on 4th day. Four weeks postoperatively, the ureteral stent was removed. After 16 weeks, the follow up abdominal computed tomography found improvement hydroureteronephrosis of the left upper moiety.

Conclusions:

  Retroperitoneal laparoscopic pyeloplasty is an effective and safe procedure to deal with complete ureteral duplications. It could preserve the all renal function, including the upper moiety. In our case, we approached the ureter through the retroperitoneal space that could avoid bowel mobilization and decrease operation time. This report further supports the trend of endoscopic surgery utilization even in cases complicated by modified renal anatomy.