Almeida G L, Busato W F S, de Cobelli O
Surgery Department, Laparoscopic Section, Catarinense Institut of Urology; University of Vale do Itajaí (UNIVALI), Itajaí, Brasil; Department of Urology, European Institute of Oncology (IEO), University of Milan, Milán, Italia.
Surgery Department, Laparoscopic Section, Catarinense Institut of Urology; University of Vale do Itajaí (UNIVALI), Itajaí, Brasil.
Actas Urol Esp. 2014 Mar;38(2):127-32. doi: 10.1016/j.acuro.2013.04.011. Epub 2013 Aug 1.
To describe a new surgical technique of the first case of totally laparoscopic repair of primary obstructive congenital megaureter with pyeloplasty, intracorporeal excisional tailoring of the ureter and nonrefluxing ureteroneocystostomy.
A 15-year-old male presented with obstructive megaureter. The standard three-port transperitoneal pyeloplasty technique and an additional 5-mm port for dynamic traction were used. Pelvic and ureteral dissection, pyeloplasty, intracorporeal excisional ureteral tailoring and nonrefluxing ureteroneocystostomy were all completed laparoscopically. A double-J stent was used to calibrate the ureter.
Operative time was 240 min. No intra and postoperative complications were observed, and there was discharge on postoperative day 2. The patient was pain-free and without urinary tract infection during the 4-month period after surgery. Follow up revealed complete resolution of the ureteral obstruction and adequate pelvic and ureteral caliber.
Laparoscopic pyeloplasty, intracorporeal excisional tailoring, and non-refluxing reimplantation are safe and effective for the treatment of obstructive congenital megaureter. The totally laparoscopic approach is reproducible and provides low morbidity with inherent cosmetic advantages.
描述首例完全腹腔镜下肾盂成形术修复原发性梗阻性先天性巨输尿管、输尿管体内切除整形及抗反流输尿管膀胱再植术的新手术技术。
一名15岁男性因梗阻性巨输尿管就诊。采用标准的三孔经腹肾盂成形术技术，并额外增加一个5毫米的端口用于动态牵引。盆腔和输尿管游离、肾盂成形术、输尿管体内切除整形及抗反流输尿管膀胱再植术均在腹腔镜下完成。使用双J支架校准输尿管。
手术时间为240分钟。未观察到术中及术后并发症，术后第2天出院。术后4个月内患者无疼痛且无尿路感染。随访显示输尿管梗阻完全解除，盆腔和输尿管管径正常。
腹腔镜肾盂成形术、输尿管体内切除整形及抗反流再植术治疗梗阻性先天性巨输尿管安全有效。完全腹腔镜手术方法可重复，发病率低，具有内在的美容优势。
