Robot‐assisted laparoscopic pyeloplasty in the management of lower pole ureteropelvic junction obstruction in a patient with an incomplete duplicated collecting system

Abstract

Introduction The performance of robot‐assisted laparoscopic pyeloplasty has recently been increasing in frequency. However, patients with duplicated renal pelvises and ureters can present challenges. Case presentation A 71‐year‐old woman presented with flank pain and was diagnosed with ureteropelvic junction obstruction with an incomplete duplicated collecting system. Preoperative imaging did not reveal the details of the stenosis. Therefore, three reconstructive procedures were prepared: The Anderson–Hynes procedure, end‐to‐side pyeloureterostomy, and upper pole ureter to lower pole pyeloplasty with the Anderson–Hynes procedure for the lower pole. These procedures were determined by the length of the intact ureter and the presence of crossed vessels. During the surgery, the crossing vein was severed, allowing successful reconstruction with Anderson–Hynes anastomosis. Conclusion Preoperative evaluation and preparation of multiple surgical techniques are crucial in robot‐assisted laparoscopic pyeloplasty for incomplete duplicated collecting systems.

Keywords

• Anderson–Hynes anastomosis
• incomplete duplicated systems
• lower pole ureter
• robot‐assisted laparoscopic pyeloplasty
• ureteropelvic junction obstruction