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Case report

  1. Top of page
  2. Case report
  3. Comment
  4. References

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).

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Figure 1. CT scan showing a horseshoe kidney with advanced hydronephrosis of the right moiety.

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Figure 2. . a, Massive dilation of the right renal pelvis and proximal 2 cm of ureter below which the entire ureter was markedly stenosed. b, The construction of the ureter from renal pelvis.

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Figure 3. Intravenous urogram 6 months after surgery showing a satisfactory right neoureter.

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Comment

  1. Top of page
  2. Case report
  3. Comment
  4. References

It is well known that horseshoe kidneys may be associated with a multitude of urological problems, including calculi, VUR and PUJ obstruction [1]. PUJ obstruction in horseshoe kidneys is usually managed by conventional pyeloplasty [2] 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 [3]. 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.

References

  1. Top of page
  2. Case report
  3. Comment
  4. References
  • 1
    Pitts WrJr, Muecke ED. Horseshoe kidneys: a 40-year experience. J Urol 1975; 113: 7436
  • 2
    Ahmed S, Crankson SJ. Non-intubated pyeloplasty for pelviureteric obstruction in children. Pediatr Surg Int 1997; 12: 38992
  • 3
    Passerini-Glazal G, Meneghini A, Aragona F, Oliva G, Milani C, Pagano F. Technical options in complex ureteral lesions: ‘ureter-sparing’ surgery. Eur Urol 1994; 25: 27480