Korean J Urol.  2015 Jun;56(6):473-476. 10.4111/kju.2015.56.6.473.

Intraureteral and intravenous indocyanine green to facilitate robotic partial nephroureterectomy in a patient with complete ureteral triplication

• Lee M
• Lee Z
• Eun D

• KMID: 2160589
• DOI: http://doi.org/10.4111/kju.2015.56.6.473

Abstract

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.

Keyword

Indocyanine green; Nephrectomy; Robotic surgical procedures

MeSH Terms

Administration, Topical
Adult
Coloring Agents/administration & dosage
Female
Humans
Indocyanine Green/*administration & dosage
Infusions, Intravenous
Nephrectomy/*methods
Pyelonephritis/surgery
Robotic Surgical Procedures/*methods
Tomography, X-Ray Computed
Ureter/*abnormalities/radiography/*surgery
Coloring Agents
Indocyanine Green

Figure

• 

  Fig. 1 (A) Coronal view suggesting three ureters, each associated with own renal pelvis. (B) Coronal view showing cortical thinning and right uppermost pole.

• 

  Fig. 2 Retrograde pyelogram showing ureteral triplication.

• 

  Fig. 3 (A) Three ureters visualized under white light. (B) Pathologic ureter highlighted under near-infrared fluorescence.

• 

  Fig. 4 (A) Kidney visualized under white light. (B) Perfusion defect delineated under near-infrared fluorescence.

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