Pyelovesicostomy: an alternative to ureteropelvic junction-plasty in pelvic ectopic kidneys

Laparoscopic Pyelovesicostomy for Ureteropelvic Junction Obstruction in a Pelvic Kidney

Pyelovesicostomy is an attractive option for treatment of ureteral obstruction in a congenital pelvic kidney or a renal allograft. We describe the first laparoscopic performance of this procedure. The total operative time was 207 minutes.

Ureteropelvic junction obstruction in anomalous kidneys

UPJ obstructions occurring in anomalous kidneys require special consideration. Many anomalous kidneys are dysmorphic with extrarenal pelves, making the distinction between obstructed and nonobstructed hydronephrosis crucial. The radiographic evaluation must be thorough because there are often other associated anomalies of the ipsilateral or contralateral kidney. Operative intervention must be tailored to the specifics of the case. Although most UPJ obstructions in anomalous kidneys can be reconstructed successfully with dismembered pyeloplasty or treated with newer minimally invasive techniques, issues regarding access, operative detail, and adjunct procedures make these cases challenging for the urologic surgeon.

Pyelovesicostomy as a form of urinary reconstruction in renal transplantation

The development of ureteral obstruction or ureteral fistula formation in the renal transplant recipient usually requires surgical repair. This involves reconnecting the donor ureter to either the recipient ureter (ureteroureterostomy) or bladder (ureteroneocystostomy), or creating an anastomosis between the renal pelvis and recipient native ureter (pyeloureterostomy). Occasionally, the donor or recipient ureter is absent, necrotic or diseased so that a ureteroureterostomy, ureteroneocystostomy or pyeloureteral anastomosis cannot be performed. In 8 such cases we have performed a direct anastomosis between the donor renal pelvis and recipient bladder (pyelovesicostomy) with a followup of between 2 months and 11 years. In all 8 patients there has been no deterioration in renal function attributed to obstruction at the anastomotic site or to the free reflux between the bladder and renal pelvis. Because of the excellent short-term and long-term results of pyelovesicostomy, this procedure should be considered as an excellent alternative to pyeloureterostomy, ureteroureterostomy and ureteroneocystostomy in the reconstruction of the upper urinary tract of the renal transplant patient.