Laparoscopic hemiureterectomy and heterotopic pyeloureteroplasty in patients with urothelial cancer of the lower part of the double kidney

Kochkin A.D., Sevryukov F.A., Puchkin A.B., Sorokin D.A., Karpuhin I.V., Semenychev D.V., Knutov A.V.

In the west countries only 2 cases of the upper urinary tract urothelial cancer (UUTUC) are registered for 100 000 individuals. The anomalic doubling of the kidney is accounted for no more as 0.8% of cases. Therefore, UUTUC of one part of the doubled kidney is extremely rare to happen. PubMed search revealed single case reports of the UUTUC located in ureter of doubled kidney. Of 11 cases 10 have received the total nephroureterectomy with bladder wall resection, in only one case – ureter was resected with the formation of the uretero-ureteral anastomosis. Prospective studies aimed at the standardization of the treatment are not possible in this patient population. Nephroureterectomy stays as a gold standard. In selected patients EAU guidelines recommend nevertheless the minimally invasive organ sparing operations as the procedure of choice. It was not possible to find any evidence to laparoscopic hemiureterectomy with heterotopic pyeloureteroplasty in case of ureteral cancer of lower part of doubled kidney, presented in this case report. The decision to preserve organ was expressed by the patient and therefore organ-sparing surgery was elected instead of nephroureterectomy. The urinary tract anomaly let us to excise the ureter completely from the ostium up to the pelvis with maximal preservation of the physiological urine transportation schema. Laparoscopic approach allowed us to perform operation minimally invasive and speed the recovery of this obese patient.

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