One-Step Laparoscopic Surgery for Two Regions : Pelvi-Ureteric Junction Obstruction and Mid Ureteral Obstruction Due to Umbilical Ligament

The patient first presented with left flank pain at the age of 15. Computed tomography (CT) and ultrasonography performed at that time revealed left hydronephrosis and hydroureter. Mid-ureteral obstruction was suspected, and he underwent balloon catheter dilation of the mid-ureteral obstruction. Hydronephrosis, hydroureter and flank pain improved after surgery. However, at 21 years of age, he again presented with left flank pain. CT and ultrasonography revealed pelvi-ureteric junction obstruction and mid-ureteral obstruction. The suspected cause of the mid-ureteral obstruction was the umbilical ligament. Renal scintigraphy showed an obstructive pattern in the left kidney, with 52% split renal function. He thus underwent laparoscopic pyeloplasty and end-to-end anastomosis of the mid-ureter with the one-step approach. No intra- or postoperative complications occurred, and the D-J stent was removed 6 weeks after surgery. At 12 months after surgery, he has had no recurrent flank pain and left renal function is normal