Ureteral duplication with lower pole ureteropelvic junction obstruction: laparoscopic pyeloureterostomy as alternative to open approach in children.

OBJECTIVES: Despite the widespread introduction of laparoscopy in pediatric urology, many reconstructive procedures, such as ureterostomy and pyeloureterostomy, are still performed in an open fashion because of the perceived intricacy and demanding nature. As we continue to introduce advanced laparoscopic skills into the care of children, we describe our laparoscopic pyeloureterostomy technique for correction of lower pole ureteropelvic junction obstruction in a pediatric patient with duplication anomaly.

METHODS: The pyeloureterostomy was performed laparoscopically, using three 5-mm trocars. We placed a double-J ureteral stent into the upper pole ureter to facilitate its identification and dissection from adjacent tissues. The anastomosis between the lower pole renal pelvis and the upper pole ureter was performed in a continuous fashion, using 5-0 polyglactin suture. A Penrose drain was left in place at the anastomosis area.

RESULTS: The child had no postoperative complications. During follow-up, his vesicoureteral reflux continued to be managed conservatively with no antibiotics. At his last follow-up visit, ultrasound examination showed improvement of both upper and lower pole hydronephrosis.

CONCLUSIONS: Laparoscopic pyeloureterostomy seems to be an effective and minimally invasive option to correct ureteropelvic junction obstruction associated with ipsilateral vesicoureteral reflux in complete ureteral duplication cases. It can be safely performed in children and represents a feasible alternative to open surgery.