Reparación totalmente laparoscópica de megauréter obstructivo primario con pieloplastia, preparación escisional completa y reimplante ureteral sin reflujo = Totally laparoscopic repair of primary obstructive megaureter with pyeloplasty, complete excisional tailoring and nonrefluxing ureteral reimplantation

Objective: To describe a new surgical technique of the first case of totally laparoscopic repair of primary obstructive congenital megaureter with pyeloplasty, intracorporeal excisional tailoring of the ureter and nonrefluxing ureteroneocystostomy. Methods: A 15-year-old male presented with obstructive megaureter. The standard three-port transperitoneal pyeloplasty technique and an additional 5-mm port for dynamic traction were used. Pelvic and ureteral dissection, pyeloplasty, intracorporeal excisional ureteral tailoring and nonrefluxing ureteroneocystostomy were all completed laparoscopically. A double-J stent was used to calibrate the ureter. Results: Operative time was 240 min. No intra and postoperative complications were observed, and the discharge was made on postoperative day 2. The patient was pain-free and without urinary tract infection during the 4-month period after surgery. Follow-up revealed complete resolution of the ureteral obstruction and adequate pelvic and ureteral caliber. Conclusion: Laparoscopic pyeloplasty, intracorporeal excisional tailoring, and non-refluxing reimplantation are safe and effective for the treatment of obstructive congenital megaureter. The totally laparoscopic approach is reproducible and provides low morbidity with inherent cosmetic advantages.