ABSTRACT
Introduction A duplicated renal collecting system is a relatively common congenital anomaly rarely presenting in adults. Aim In this video we demonstrate our step-by-step technique of Robotic heminephrectomy in a patient with non-functioning upper pole moiety. Materials and Methods Following cystoscopy and ureteral catheter insertion the patient was placed in 600 modified flank position with the ipsilateral arm positioned at the side of the patient. A straight-line, three arm robotic port configuration was employed. The robot was docked at a 90-degree angle, perpendicular to the patient. Following mobilization the colon and identifying both ureters of the duplicated system, the ureters were followed cephalically toward, hilar vessels where the hilar anatomy was identified. The nonfunctioning pole vasculature was ligated using hem-o-lok clips. The ureter was sharply divided and the proximal ureteral stump was passed posterior the renal hilum. Ureteral stump was used as for retraction and heminephrectomy is completed along the line demarcating the upper and lower pole moieties. Renorrhaphy was performed using 0-Vicryl suture with a CT-1 needle. The nonfunctioning pole ureter was then dissected caudally toward the bladder hiatus, ligated using clips, and transected. Results The operating time was 240 minutes and blood loss was 100 cc. There was no complication post-operatively. Conclusions Wrist articulation and degree of freedom offered by robotic platform facilitates successful performance of minimally invasive heminephrectomy in the setting of an atrophic and symptomatic renal segment. .
Subject(s)
Female , Humans , Young Adult , Kidney Tubules, Collecting/abnormalities , Kidney Tubules, Collecting/surgery , Nephrectomy/methods , Robotic Surgical Procedures/methods , Ureter/surgery , Operative Time , Reproducibility of Results , Treatment OutcomeABSTRACT
Duplication of renalcollecting system in neurofibromatosis type 1 NF1 is reported. The patient, the son of a mother with NF 1, was 10 months old who presented with acute febrile respiratory distress. In addition there were significant cafe' au-lait spots on the trunk and freckles in right axilla,macrocephaly,pectus excavatum, pulmonary stenosis and right palpable kidney, findings consistent with the diagnosis of NF1.To the best of our knowledge such association. which may have genetic basis, lias not been previously reported
Subject(s)
Humans , Kidney Tubules, Collecting/abnormalities , Kidney/abnormalitiesABSTRACT
Two examples of the rare case of complete duplicated collecting system with lower pole ureteropelvic junction obstruction are described. Ureteropelvic junction obstruction (UPJO) and duplicated collecting systems seldom occur in combination. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obstruction, damage and potential for regeneration in growing kidneys. The diagnosis and management of UPJO of the lower pole in complete duplicated collecting systems are discussed.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Kidney Pelvis , Kidney Tubules, Collecting/abnormalities , Ureteral Obstruction/complications , UreterostomyABSTRACT
Las alteraciones de la fusión renal se presentan frecuentemente asociadas a otras malformaciones renales, Se presenta en este artículo el caso de una paciente de 26 años de edad, asintomática durante la infancia, que inició su padecimiento con un cuadro de pielonefritis aguda con infección ulterior recurrente de vías urinarias; durante la protocolización del estudio se encontró un riñón en herradura con doble sistema colector completo e hidonefrosis del superior. Se sometió a lumbotomía exploradora y se realizó polectomía, y se identificó compresión extrínseca de la unión ureteropiélica izquierda por una vena renal accesoria
Subject(s)
Humans , Female , Adult , Nephrosis/etiology , Pyelonephritis/etiology , Kidney/abnormalities , Kidney/surgery , Kidney Tubules, Collecting/abnormalitiesABSTRACT
Se revisaron retrospectivamente los resultados del tratamiento de 34 niños de doble sistema colector, entre los que predominó la duplicación completa de 82 por ciento. La anomalía acompañante más frecuente el reflujo vesicoureteral en 47 por ciento de los casos, seguido del ureterocele en 24 por ciento y uréter ectópico en 12 por ciento. Sus manifestaciones clínicas más frecuentes fueron infección de vías urinarias, tumoración abdominal e incontinencia, en orden de frecuencia. El diagnóstico se logró mediante urograma excretor en 80 por ciento de los casos, y se complementó con ecosonograma, uretrocistograma y gammagrama renal. Los procedimiento quirúrgicos realizados consistieron en reimplantación ureteral de tipo de Cohen, heminefrectomía y ureteroureteroanastomosis con resultados satisfactorios en 90 por ciento de los casos. Las complicaciones más frecuentes ocurrieron en los casos de reimplantación, con 9 por ciento por estenosis. Se concluye que la conducta quirúrgica definitiva depende de la individualización de cada caso según el tipo de anomalías, y del grado de funcionalidad de los segmentos renales implicados