用于婴幼儿长窄PUJO的一次性肾盂成形术

                               
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Spatulation of the ureter is one of the most important & difficult steps of laparoscopic pyeloplasty, especially in infants. It is even more difficult in case of a long stenotic segment of upper ureter at the PUJ. However, the magnified & panoramic view of the ureter offered by laparoscopy may be used as an advantage in such cases. This video demonstrates the ureteric spatulation in a case of long narrow segment PUJO in a 2 month old infant with right-sided PUJ obstruction. The spatulation part is only minimally edited to illustrate the essential steps in this difficult case. The long segment of narrow & convoluted ureter is unmistakably identifiable at laparoscopy. The ureter is then gently mobilized. The spatulation is started proximally & continued till the wide normal ureter is reached distally. The external appearance of the convoluted ureter acts as a guide to the extent of distal spatulation. Once the spatulation goes beyond this point, the wide, normal ureter immediately becomes apparent. The narrow segment in this case measured about 4cm. The pyeloplasty itself is not detailed much in this video; I have posted it in earlier videos. However the excellent orientation of the new PUJ at the end of the pyeloplasty can be appreciated.