Laparoscopic Renal Descensus for Upper Tract Reconstruction

Abstract

We describe a modern use of laparoscopic renal descensus during the reconstruction of the upper urinary tract. The patient is a 76-year-old mononephric man with recurrent carcinoma in situ in the distal ureter. Using the described technique, we produced an additional 8 to 10 cm of ureteral length and performed a simple ureteroneocystotomy instead of using a traditional psoas hitch and Boari flap creation, bowel interposition, or autotransplantation. Laparoscopic renal descensus is an uncommonly used but simple procedure that may prevent the need for bladder mobilization or Boari flap creation, particularly in the setting of a hostile pelvis.

Clinical reappraisal and state of the art of nephropexy

“…For proximal ureteral reconstruction, inferior nephropexy can be used in conjunction with other techniques covering large ureteral defects, up to 12 cm long, reducing the need for bowel interposition. 29,31,45 Although it has been clearly demonstrated that DN is effective and versatile, the adaption of this technique is very limited and review of the current literature reveals a paucity of data regarding urothelial-based reconstructions of the upper and mid-ureter (Table 5).…”

“…For proximal ureteral reconstruction, inferior nephropexy can be used in conjunction with other techniques covering large ureteral defects, up to 12 cm long, reducing the need for bowel interposition. 29,31,45…”

Surgical options in the management of ureteropelvic junction obstruction

“…It can safely be performed laparoscopically if necessary [33]. The kidney is circumferentially mobilized and pexed to the posterior and lateral body walls as caudal as possible with an absorbable suture.…”