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19–22 APRIL, 2017, BARCELONA, SPAIN
RESULTS
At intervention a bifid ureter was evidenced which joined just after the exit of the pelvis of the lower
pole to a single ureter. Ureteropyelostomy of the right lower pole was performed and a JJ stent was
inserted leaving the proximal end in the lower pole pelvis. The patient was discharged unevent-
fully on the second postoperative day. Ultrasound 1 year after surgery revealed improvement of
hydronephrosis with only residual chaliceal dilatation and she remained assymptomatic.
CONCLUSIONS
Incomplete ureteral duplication with a bifid ureter is rare and can be difficult to diagnose by conven-
tional imaging techniques. The intraoperative incidental finding of this rare condition may require
technical changes for its resolution.
VS-25 (VS without presentation)
CROSSING GONADAL VESSELS LEADING
TO LAPAROSCOPIC DISMEMBERED PYELOPLASTY
IN A THREE MONTHS OLD GIRL WITH A SINGLE KIDNEY
Erika LLORENS DE KNECHT, Anna BUJONS, Jorge CAFFARATTI,
Antonio ROSALES and Humberto VILLAVICENCIO
Fundació Puigvert, Pediatric Urology, Barcelona, SPAIN
INTRODUCTION
Most ureteropelvic junction obstructions (UPJ) are identified and diagnosed in the perinatal period.
UPJ obstruction is the most common cause of significant dilatation of the collecting system in the
fetal kidney. Bilateral UPJ obstruction is present in 10% to 40% of cases. An aberrant, accessory or
early-branching lower-pole vessel is the most common cause of extrinsic UPJ obstruction.
MATERIAL AND METHODS
We present the case of a 3 month-old girl prenatally diagnosed of bilateral hydronephrosis in which
the postnatal CT scan showed an atrophied left kidney and right kidney ureterohydronephrosis.
A nephrostomy tube was placed in the perinatal period due to renal function deterioration. We
performed a laparoscopic dismembered pyeloplasty with 5mm instruments and during the surgery
crossing gonadal vessels were found to be the cause of the obstruction. We explain the procedure
and share our results.
RESULTS
The operating time was 120 minutes with no significant blood loss. length of in hospital stay was
5 days. One month post surgery the renal scan showed moderately slowed tracer elimination with
renal function improvement and without scintigraphic signs of obstruction. Blood serum creatinine
and glomerular filtration rates are now within normal limits and the cosmetic appearance is excellent.
CONCLUSIONS
The role of crossing gonadal vessels should be considered as potential causes of ureteropelvic
junction obstruction. A laparoscopic dismembered pyeloplasty is a safe and feasible treatment ap-
proach, and in our experience with optimal results.