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Laparoscopic Management of Atypical Ureteropelvic Junction Obstruction: Alternative and Simple Techniques for Complex Situations

Purpose: We describe novel and simple techniques for management of cases of atypical and complex ureteropelvic junction (UPJ) obstruction. Material and Methods: Three cases of atypical UPJ obstruction were operated laparoscopically. Calicovesicostomy, pyelovesicostomy and ureteropyelostomy were performed laparoscopically as per the merits of each case. The 4-port technique was followed for calicovesicostomy and pyelovesicostomy (two 10-mm ports, one each at the umbilicus and lateral border of ipsilateral rectus and two 5-mm ports, one each at the lateral border of the contralateral rectus and midway between umbilicus and symphysis pubis). Both anastomoses were stented with a suprapubically placed Foley catheter. Laparoscopic ureteropyelostomy was done with port sites similar to standard laparoscopic pyeloplasty. Two double-J stents were placed, one in each moiety. Results: Mean operating time was 180 min and intraoperative blood loss was negligible. There were no intraoperative complications. The patients recovered well from the surgery. Postoperative nephrostograms confirmed anastomotic patency and good drainage. On follow-up, patients are doing well and asymptomatic. Patients with calicovesicostomy and pyelovesicostomy were advised double voiding. Conclusions: In select cases of giant hydronephrotic kidneys, anastomosis of the bladder with the most dependent part of pelvicalyceal system ensures adequate drainage. In UPJ obstruction with ureteral duplication, ureteropyelostomy with two double-J stents can be performed with good functional results. Laparoscopic performance of these procedures is feasible and simple.