Laparoscopic pyeloplasty in complex cases of hyperrotated kidney

Introduction

In hyperrotation, the kidney rotates more than 1800, but less than 3600. The pelvis faces laterally, but the renal vessels are carried posteriorly to the kidney. Ureteropelvic junction obstruction in hyperrotated kidney is associated with an exaggerated intrarenal collecting system and not amenable to standard dismembered pyeloplasty.

We hereby present new technique of laparoscopic pyeloplasty, which combined Culp-Scardino pyeloplasty with calico-pyelostomy.

Surgical technique

The flap is created from the anterior surface of the renal pelvis and its base was located inferiorly according Calp-Scardino procedure. Then medial edge of incision extends on anterior surface to the lower infundibulum and calyx. The cavities of the pelvis and lower calyx are connected by intermittent sutures. The reconstruction is being completed after ureteropelvic junction is created. In all cases externalized stent was utilized.

Result

The method was successfully performed in 8 children. No Intraoperative and postoperative complications were noted. The patients were followed for a mean time of 14 months. Postoperative ultrasound showed significant decrease diameter of the calices.