Horseshoe kidney with hydronephrosis secondary to ureteric stenosis: construction of a ureter from the renal pelvis
Article first published online: 28 JUN 2008
Volume 83, Issue 1, pages 146–147, January 1999
How to Cite
Al-Shamsi, A., Abudaia, J., Al-Sabban, E. and Ahmed, S. (1999), Horseshoe kidney with hydronephrosis secondary to ureteric stenosis: construction of a ureter from the renal pelvis. BJU International, 83: 146–147. doi: 10.1046/j.1464-410x.1999.00858.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
A 4-year-old boy presented with a 6-month history of recurrent abdominal pain. There was a large right upper abdominal mass but no other positive findings. Abdominal CT showed a horseshoe kidney with advanced hydronephrosis of the right moiety, considered to be secondary to PUJ obstruction (Fig. 1). A renal nuclide scan confirmed the diagnosis, with the right moiety contributing ≈30% of total function. The kidney was approached via a transverse upper abdominal transperitoneal incision. There was massive dilatation of the right renal pelvis and proximal 2 cm of the ureter, below which the entire ureter was markedly stenosed and unsuitable for surgical reconstruction (Fig. 2a). It was decided to construct a ureter from the dilated renal pelvis, as shown in Fig 22b. The neoureter was reimplanted into the bladder by the extravesical technique, leaving a JJ stent in situ. The postoperative recovery and clinical progress were satisfactory; the stent was removed after 3 months and IVU at 6 months was satisfactory (Fig. 3).
It is well known that horseshoe kidneys may be associated with a multitude of urological problems, including calculi, VUR and PUJ obstruction . PUJ obstruction in horseshoe kidneys is usually managed by conventional pyeloplasty  but the present case was unique in that almost the entire ureter was stenotic and unsuitable for reconstruction. The alternatives in such a case included nephrectomy of the affected segment, which was not justified. Other techniques for bridging the ureteric gap were also unsuitable . However, a tubed pedicle of the enormously distended renal pelvis proved to be a very suitable neoureter. This case illustrates this technique, which would be applicable in patients with a large renal pelvis and deficient or absent distal ureter.
- 3Technical options in complex ureteral lesions: ‘ureter-sparing’ surgery. Eur Urol 1994; 25: 274–80, , , , , .