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Outcome of Laparoscopic Upper-Pole Nephrectomy in Children with Duplex Systems

2007; Mary Ann Liebert, Inc.; Volume: 21; Issue: 2 Linguagem: Inglês

10.1089/end.2006.0228

1557-900X

Francisco Tibor Dénes, Alexandre Danilovic, Miguel Srougi,

Urinary and Genital Oncology Studies

Purpose: To report the results of laparoscopic upper-pole nephrectomy for children with duplex systems. Patients and Methods: Nineteen laparoscopic transperitoneal upper-pole nephrectomies (11 on the left and 8 on the right) were performed in 17 patients with complete pyelocaliceal duplication. Postoperative follow-up consisted of clinical evaluation, as well as functional and image studies of the remaining lower unit with renal ultrasonography, 99mTc-DMSA, voiding cystourethrography, and urography or enhanced helical CT, according to individual needs. Results: The mean operative time was 147 minutes (range 110–180 minutes). There were no conversions to open surgery and no transfusions. The mean follow-up was 57.1 months. Lower-unit function was preserved after 18 procedures (94.7%). Transient asymptomatic urinary-tract infection was observed in 5 of 17 children (29.4%). Vesicoureteral reflux resolved in 3 of 4 children (75%) and improved in the other, and all 7 ureteroceles associated with the resected upper unit were decompressed, although two (28.6%) remained present asymptomatically by ultrasonography. Empyema of the lower-ureteral stump was a late complication in 3 of the 19 duplex systems. Conclusion: Laparoscopic transperitoneal polar nephrectomy in children with pyelocaliceal duplication is feasible and presents all the advantages of minimally invasive procedures. It has good long-term results, as judged by preservation of the lower unit, regression of ureterocele and reflux, and reduction in the incidence of infection.