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TH
CONGRESS OF THE ESPU
Before redo surgery, workup included ultrasound, CT scan and renal scan.
The patient was placed in supine position. Four 5-mm ports were placed.
The colon was reflected medial.
Extensive fibrotic changes made dissection of the small right intrarenal pelvis, covered by the renal
vessels, impossible.
The proximal ureter was dissected to the point of obstruction, and the ureter was ligated with ab-
sorbable suture and transected at that level. The ureter was then trimmed back to a point at which
it was well vascularized and it was spatulated.
Renal parenchyma was excised from the anastomotic site to enter substantially the lower pole calix
and to prevent reobstruction.
Neither cross clamping of the renal hilum nor coagulation were done to control bleeding from the
cut parenchymal margin.
A mucosa-to-mucosa ureterocaliceal anastomosis was performed with running 5-zero absorbable
suture over a JJ stent.
No omental or peritoneal flap was brought to the anastomotic site. A drain was inserted.
RESULTS
Total operating time was 240 minutes with minimal resultant blood loss. He recovered well and was
discharged home on postoperative day 2.
At 1 year, patient remains without symptoms and a renal scan at 6 months showed further improve-
ment in drainage.
CONCLUSIONS
The success of ureterocalicostomy depends not only on the patency of the anastomosis, but also
on providing gravity-dependent drainage.
VS-24 (VS without presentation)
BIFID URETER AND PELVI-URETERIC JUNCTION
OBSTRUCTION OF THE LOWER POLE: A DIAGNOSTIC
AND TECHNICAL CHALLENGE
Marino ASENSIO
1
, Romy GANDER
1
, Gloria Fatou ROYO
1
and Manuel LOPEZ
2
1) Hospital Vall d'Hebron Barcelona, Pediatric Surgery. Pediatric Urology and Renal Transplant Unit, Barcelona, SPAIN
- 2) Hospital Vall d'Hebron Barcelona, Pediatric Surgery, Barcelona, SPAIN
PURPOSE
Ureteral duplication is one of the most common urological malformations. However, incomplete
ureteral duplication with a bifid ureter is rare. The majority of the reported cases are blind ending
bifid ureters and are diagnosed by urinary tract infections (UTI), stones or neoplasia. We describe
a case of bifid ureter associated with pelvi-ureteric junction obstruction (PUJO) of the lower pole.
MATERIAL AND METHODS
Nine year old female patient who was referred to our hospital for right renal duplication and hy-
dronephrosis of the lower pole, after 1 febril UTI. The renogram revealed a functioning lower-pole
(right kidney 40%) with severe cortical thinning and excretory difficulty (obstructive pattern). The
uro-magnetic resonance evidenced dilated chalices but a large dilated pelvis was not seen. Renal
ultrasound revealed a 16 mm pelvis with large dilated chalices but without dilatation of the distal
ureter. The patient was scheduled for robotic pyeloplasty of the right lower pole.