Abstract

  A 67-year-old woman was aware of right back pain during the examination for abdominal aortic aneurism. CT showed the horseshoe kidney with right hydronephrosis and a 10mm ureteral stone. Further examination revealed that the right ureter was crossed and compressed by a renal lower polar artery and aortic aneurysm. Laparoscopic ureterolithotomy was performed via transperitoneal approach. The patient was fixed on half lateral decubitus position to prepare for the emergent rupture of the aneurysm during surgery. The anterior wall of the dilated ureter was incised and the calculus was removed with a flexible cystoscope. The ureter was transected and moved to the ventral side of the crossing artery followed by uretero-uretero anastomosis. Although horseshoe kidney has been characterized by various morphological abnormalities, laparoscopic surgery was safely performed by precise anatomical recognition of the blood vessels and urinary tract with preoperative imaging studies.