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Principles of Minimally Invasive Treatment of Pyeloureteral Duplication in Children - Abstract

Sebastian Ionescu, Bogdan Andrei, Mihai Mocanu, Elena Licsandru, Daniela Pavel



Aims: The most common complication in complete or partial pyeloureteral duplication is damage of the upper renal pole due to vesicoureteral reflux or ureterocele, condition that requires partial nephrectomy or ureteronephrectomy. The purpose of this study is to present and analyze the treatment results using the minimal invasive approach in complications of pyeloureteral duplication in children.

Materials and methods: We present 28 cases of upper pole nephrectomy in children with complete or partial pyeloureteral duplication. In all cases there was a non-functional renal upper pole due to the presence of vesicoureteral reflux in 20 cases and ureterocele in 8 cases. The laparoscopic approach was transperitoneal (in 26 cases) or retroperitoneal (in 2 cases). The mean age of the children was 6 (range 2-12). Preoperative evaluation included renal ultrasound, voiding cystourethrogram, intravenous urography, renal scintigraphy and blood analysis. We analyzed data concerning the operative time, the use of analgesics and antibiotics, the time to resume oral feeding, hospital stay and postoperative renal function.

Results: The mean operative time was 120 minutes but longer for the retroperitoneal approach. There were 2 types of complications: one intraoperative hemorrhage which required conversion and one postoperative urinoma treated with local drainage. Pain medication was required only in the first 2 days after surgery. The mean postoperative hospital stay was 4 days. The postoperative renal function of the lower pole, evaluated by blood samples (blood urea nitrogen, plasma creatinine) and scintigraphy was normal in all cases during 1 year postoperative follow-up.

Conclusion: Laparoscopic transperitoneal or retroperitoneal partial ureteronephrectomy is a safe and feasible procedure in children. We consider that laparoscopy offers a better visualization of the vessels to be ligated and the dissection plans. Using minimal access surgery, we had shorter postoperative recovery, good aesthetic postoperative scars and shorter hospital stay. For the reasons mentioned above, this technique is first choice over open partial nephrectomy.

Keywords: pyeloureteral duplication, minimally invasive, children, nephrectomy


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