The laparoscopic resection of recurrent tumor should be encouraged in highly selected cases. The minimally invasive method, with its known advantages, especially for more debilitated patients, can be advantageous when applied to suitable cases.
Introduction: The pre-ureteral vena cava anomaly, erroneously termed the retrocaval or circumcaval ureter, is a relative rare condition of extrinsic ureteral obstruction. Despite being more common on the right kidney, when present on the left side, it is usually associated with sites inverses. The laparoscopic approach, with all of its know advantages, has good results when used to treat this congenital anomaly. The present surgical video shows a ureteral transposition with ureteropyolostomy, associated with a nephroscopic calyceal calculi extraction. Case Report: A 54 years old man, with discomfort in the right flank and abdominal echography showing a pelvicalyceal dilatation of this side and a calculus of 1.5 cm in a lower calyx. An intravenous pyelogram and abdominal computed tomography showed an S-shaped (Atkinson classification) pre-ureteral vena cava, and a mid-ureteral extrinsic stricture associated with it. There were no patient pre-operative comorbities and a percutaneous nephrolithotripsy was done 4 years prior on the right kidney. In the present video, a transperitoneal laparoscopic approach was conducted, with 4 trocars. In a stepwise fashion, the ureter sub-and supracaval was gently dissected, sectioned near the renal pelvis, transposed, and spatulated .A ureteropyelostomy was done over a double J stent, which was placed in an antegrade manner. After the posterior wall anastomosis completed, we performed a nephroscopy through the left hand trocar and the calyceal stone was removed by percutaneous stone instrumentation. Result: The surgery lasted 240 minutes, with minimum blood loss. The diet was resumed on the first postoperative day and he was discharged home on the third postoperative day. After 8 months of follow up, the patient remains asymptomatic and his excretory urography shows good drainage of the right kidney as well a diuretic renography reveals good response following 20 minutes after furosemide intravenous administration. Furthemore, the pelvicalyceal dilatation improved and there are no subsequent calculi. Conclusion:The laparoscopic approach to circumcaval ureteral anomalies is a feasible option, with concomitant endourologic procedures possible with good results.
ANTECEDENTES: la localización anómala del riñón en el espacio retroperitoneal se denomina ectopia renal. La ectopia renal cruzada constituye una malformación congénita excepcional con incidencia de 1 caso por cada 1350 a 1 por cada 2000 nacimientos. El tumor más común reportado en alteraciones de la fusión renal es el carcinoma de células renales. Las anomalías de la fusión renal aumentan cuatro veces el riesgo de neoplasias.CASO CLÍNICO: paciente masculino de 64 años de edad con antecedentes oncológicos de ectopia renal y pulmonar. En los estudios de rutina se detectó una masa en la fusión de ambos riñones. Se realizó istmectomía con plastia ureteral, con colgajo de Scardino y colocación de catéter doble J mediante laparoscopia asistida por robot.CONCLUSIÓN: la ectopia renal fusionada cruzada se origina por el desarrollo anormal de la yema ureteral y el blastema metanéfrico durante la cuarta y octava semanas del embarazo. Después del riñón en herradura, la ectopia renal cruzada fusionada es la anormalidad renal más frecuente. La ectopia renal cruzada es una alteración congénita poco frecuente; el cruce de izquierda a derecha es frecuente, contrario al caso aquí reportado. La relación de tumores malignos con estas anomalías representa un evento excepcional. La anatomía es impredecible, se observan anomalías vasculares en 70% de los casos lo que complica el manejo quirúrgico. Diversos estudios han intentado establecer el origen del fenotipo sarcomatoide y su relación con cualquiera de los patrones histológicos clásicos del carcinoma renal.PALABRAS CLAVE: ectopia renal cruzada, ismectomía y tumor renal.
Introduction:The main structures involved in maintaining the integrity of the pelvis include the ureterosacral ligament, pubocervical fascia, and the paracervical tissues. A compromise to any of these areas can promote a weakness leading to herniation or prolapse of the urethra, bladder, and/or rectum. Hydronephrosis can range from 5% in first-degree to 40% in patients with third-degree prolapse. A variety of laparoscopic techniques has been described and some have used meshes as an integral part for the repair. This approach aims to restore normal voiding function while preserving female sexual function. Here, we provide a video of a pelvic organ prolapse (POP) female patient with bilateral pyelocaliceal dilation, that was corrected through a laparascopic sacrocolpopexy with mesh technique. Methods: A 56 year-old female, complained of a ball in your vagina and just evacuated fezzes with aid of the fingers introduced inside the vagina. Her physic exam evidenced a grade 4 pelvic prolapse, bringing down rectum, bladder and urethra and probably kinking bilaterally the ureters, since IVP exam showed a dilated right kidney, almost without function, and the left with a delayed excretion. A laparoscopic correction of the POP was proposed. A 4 ports pneumoperitoneum was utilized. We dissected the retovaginal and bladder vaginal spaces. The mesh was sutured posterolaterally to the distal levator ani muscles, and centrally to central perineum tendon. Anteriorly, the mesh was sutured to the anterior vaginal wall and then passed through the broad ligaments. Both meshes were trimmed and sutured to the anterior longitudinal ligaments of the sacral promontory. The Douglas pouch and peritoneal incision were closed and a transobturator sub-urethral sling was positioned. Results: The surgery lasted 240 minutes, with a minimum blood loss and just paracetamol was used for postoperative pain. She was discharged in 3 days and her 2 months contrast exam showed pelvic organs in a correct location and better contrast elimination of both kidneys. After a follow up of 12 months, she is continent, with no prolapse recurrence. Conclusion: Despite some authors contesting the type of access required to correct the pelvic prolapse, undoubtedly the laparoscopic approach provides more anatomic detail, a clear surgical field, better cosmesis, and an early return to physical activity. Moreover, we showed that laparoscopic mesh approach for sacrocolpopexy is feasible, with a minimum morbidity, even in the context of bilateral hydronephrosis secondary to POP. To our knowledge, this is the first published case approached in such a manner in the scientific literature.
ANTECEDENTES: Los quistes broncogénicos son formaciones congénitas provenientes del desarrollo fetal anómalo del árbol traqueobronquial. El sitio más común es el tórax; sin embargo, se han reportado casos excepcionales en el abdomen, debido al retraso en la migración de estructuras abdominales durante la gestación. CASO CLÍNICO: Paciente femenina de 53 años de edad, que acudió al servicio de Urgencias con dolor agudo en la fosa renal izquierda, sin reacción al tratamiento con analgésicos convencionales. La urotomografía computada evidenció la glándula adrenal con una masa de bordes bien definidos, de 7.1 x 4.3 x 6.0 cm, sin realce con la administración del medio de contraste (densidad promedio de 37 UH), sugerente de un quiste con contenido denso. La resonancia magnética en secuencia T2 mostró una masa retroperitoneal adyacente a la parte interna del riñón, que desplazaba la glándula suprarrenal izquierda, de 38 x 67 mm de diámetro en corte axial. En secuencia T1 se comportó de manera hiperintensa, pero no se observó reforzamiento con el paso del medio de contraste, que también fue sugerente de un quiste. Se decidió la adrenalectomía laparoscópica izquierda, sin complicaciones transquirúrgicas y con sangrado estimado de 100 cc. Con el reporte histopatológico se estableció el diagnóstico de quiste bronquial subdiafragmático.CONCLUSIÓN: Los pacientes con quistes broncogénicos suelen cursar asintomáticos y su diagnóstico es fortuito. El tratamiento retroperitoneal consiste en la extirpación quirúrgica. Los quistes broncogénicos deben considerarse en el diagnóstico diferencial de masas suprarrenales.PALABRAS CLAVE: Quiste broncogénico; laparoscopia; glándula suprarrenal; adrenalectomía; quiste broncogénico retroperitoneal.
ANTECEDENTES: la localización anómala del riñón en el espacio retroperitoneal se denomina ectopia renal. La ectopia renal cruzada constituye una malformación congénita excepcional con incidencia de 1 caso por cada 1350 a 1 por cada 2000 nacimientos. El tumor más común reportado en alteraciones de la fusión renal es el carcinoma de células renales. Las anomalías de la fusión renal aumentan cuatro veces el riesgo de neoplasias.CASO CLÍNICO: paciente masculino de 64 años de edad con antecedentes oncológicos de ectopia renal y pulmonar. En los estudios de rutina se detectó una masa en la fusión de ambos riñones. Se realizó istmectomía con plastia ureteral, con colgajo de Scardino y colocación de catéter doble J mediante laparoscopia asistida por robot.CONCLUSIÓN: la ectopia renal fusionada cruzada se origina por el desarrollo anormal de la yema ureteral y el blastema metanéfrico durante la cuarta y octava semanas del embarazo. Después del riñón en herradura, la ectopia renal cruzada fusionada es la anormalidad renal más frecuente. La ectopia renal cruzada es una alteración congénita poco frecuente; el cruce de izquierda a derecha es frecuente, contrario al caso aquí reportado. La relación de tumores malignos con estas anomalías representa un evento excepcional. La anatomía es impredecible, se observan anomalías vasculares en 70% de los casos lo que complica el manejo quirúrgico. Diversos estudios han intentado establecer el origen del fenotipo sarcomatoide y su relación con cualquiera de los patrones histológicos clásicos del carcinoma renal.PALABRAS CLAVE: ectopia renal cruzada, ismectomía y tumor renal.
Objective: About 10% of renal pelvis are bifids and not so there is a larger index of kidney disease over the normal pelves. The laparoscopy and minimally invasive techniques treat the ureteropelvic junction disease in a low agressive manner. We showed a video of an atypical pyeloplasty of ureteropelvic junction obstruction of a lower unit. The patient is a 33 year-old woman with an intermitent lumbar pain for 3 years. Your image exams showed a bifid left pelvis with a stenosis of the lower unit. We chose to do the fix of this pathology laparoscopically. Materials and Methods:We positioned the patient in a right lateral decubitus and 3 trocars was placed, we identify the obstructed junction and a terminolateral anastomosis was performed. Results: The procedure lasted 95 minutes, with little blood loss and the patient was discharged in 2 days. We withdraw the double J catheter after 1 month, a pyelography and a ureteroscopy was performed which showed a pervious anastomosis. After 2 months of follow-up the patient is doing well. Conclusions: As far as we know, this is the first case of literature with correction by laparoscopy. The stenosis of ureteropelvic junction in the lower unit of a bifid pelvis can be corrected effectively by laparoscopic surgery. _______________________________________________________________________________ ARTICLE INFO
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