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Poster Display - 63
Laparoscopic Management of Hugely Dilated Malrotated Renal Pelvis in Cases of Pelvi-Ureteric Junction Obstruction: Case Series from a Tertiary Care Hospital of India
Rahul Goel, Pooja Prajapati, Vijai Datta Upadhyaya, Anju Verma
SGPGIMS, Lucknow India
Aim: Pelvi-Ureteric Junction Obstruction (PUJO) has an estimated incidence of 1 in 1000 to 1500. It is more commonly seen in the paediatric age group than in adults, and this anatomical pathology is observed more frequently in boys than in girls, with up to twice the number of cases in males compared to females. The left side is also affected twice as often as the right side. It is the most common cause of antenatally detected hydronephrosis, accounting for around 80% of all cases. This activity reviews the evaluation and management of PUJO in cases of severely dilated pelvis with malrotation via a laparoscopic route.
Materials and methods: There were 5 patients: 1 male and 4 females. The mean age of presentation was 2.5 years, and most of the patients were asymptomatic and detected antenatally. Two patients presented with abdominal swelling. All patients underwent thorough workups, including blood investigations, ultrasonography, and nuclear scans. All patients were managed laparoscopically, and no patient required conversion to open surgery. One patient developed recurrent PUJO and required reoperation. All patients are now on follow-up.
Results: Our case series observed that such patients fared well after adequate pelvi- ureteric anastomosis, with rapid improvement in renal function. Complications requiring surgical intervention occurred in 1 (20%) patient, necessitating redo pyeloplasty. One patient required admission for a UTI, which subsided after IV antibiotics and stent removal.
Conclusion: In our cases, the malrotated and severely dilated pelvis posed difficulties in operating via the laparoscopic route. However, all cases demonstrated improvements in scintigraphic kidney function, enhancements in ultrasound examinations, and remission of symptoms following pyeloplasty. Prophylactic antibiotics and rigorous surveillance during the postoperative period play a crucial role in such cases. Most complications occur within 2 years after surgery, and long- term follow-up is essential