Category: Laparoscopy: Upper Tract - Benign
Introduction & Objective :
Giant hydronephrosis is an uncommon entity. Treatment of this complex problem depends on various factors mainly functional status and pelvicalyceal anatomy of the affected kidneys as well as the clinical presentation of the patient. Limited literature exists on the laparoscopic and robotic management of this entity with most cases being managed by open surgery, associated with increased morbidity. We aim to present the case of a young female who presented to us with bilateral giant hydronephrosis secondary to uretero-pelvic junction obstruction (UPJO) and was managed by bilateral simultaneous robot assisted ‘Santosh Post Graduate Institute tubularized flap pyelovesicostomy’.
A 15 year old girl presented to the outpatient department of our hospital with bilateral dull aching flank pain and vomiting. On evaluation, she was found to have a raised serum creatinine of 1.8mg/dL and CECT abdomen revealed the presence of bilateral giant hydronephrosis. She was drained pre-operatively by placing percutaneous nephrostomy (PCN) on both sides and underwent bilateral Robot assisted ‘Santosh Post Graduate Institute tubularized flap pyelovesicostomy’ simultaneously. The patient was placed in left lateral position. A baggy pelvis was revealed after mobilization of the colon and an anterior rectangular flap was created on the most dependent part of the pelvis. A 3 cm cystostomy was created on the anterolateral wall of the bladder. The posterior layer of the pyelovesicostomy was performed in a continuous fashion using polyglactin 1/0 and the flap was tubularized over a 16 fr foleys catheter placed suprapubically using polyglactin 3/0 sutures in a continuous fashion. The position was changed and the procedure was repeated on the r side. The operative time was 180 minutes with blood loss of 100 ml.
The post-operative period was uneventful. Bilateral PCN were clamped on post-operative day (POD)3 and drains removed on POD5. The splints were removed after 3 weeks on an outpatient basis. 18 months pot-operatively, the patient is doing well and voiding normally. Her serum creatinine is stable at 0.9 mg/dL.
Robot assisted Santosh Post Graduate Institute tubularised flap pyelovesicostomy is a safe , feasible and easily reproducible procedure suitable and effective in salvaging unilateral or bilateral giant hydronephrotic kidneys with baggy redundant extrarenal pelvis.
Professor of urology
Chandigarh, Chandigarh, India
As a professor of urology at a one of the most premier institute ie. PGIMER, Chandigarh • i published 160 article in international journal of repute ie PUBMED indexed.
Contributed significantly in theGenito-Urinary Carcinoma , stones, reconstructive and laparoscopic and Robotic surgical cases . New surgical techniques developed by me to simplify the surgery, reduce the blood loss in surgery, decrease hospital stay and operative duration.
• Actively involved in regular bed-sides teaching of junior and senior residents as a consultant.
• Regularly coordinating interdepartmental academics meets of radiotherapy and urology case related to management of genitourinary cancers.
• Regularly coordinating interdepartmental academics meets of urology and radiotherapy case related to management of genitourinary cancers, urology and nephrology clinical rounds, urology and radiology rounds..
Developed many new surgical techniques
• Teaching of both the MS (General surgery) and MCh (Urology ) residents by the way of taking teaching rounds, decision making, seminars and bed-side classes in both routine and emergency wards
• Teaching of residents of other disciplines like Radiology, Gynae & Obstetrics
• Teaching of ‘visitor residents’ from other institutions from other places coming to our hospital for training
• Teaching residents regarding publication and presenting in national and international conferences