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Pohl HG. Embryology, Treatment, and Outcomes of Ureteroceles in Children. Urol Clin North Am 2023; 50:371-389. [PMID: 37385701 DOI: 10.1016/j.ucl.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
A ureterocele is a congenital cystic dilatation of the intravesical ureter that may affect either a single system kidney or the upper pole of a duplex system. The position of ureteral orifice correlates with function of associated renal moiety. Ureteroceles associated with good renal function and prompt drainage or ureteroceles associated with no renal function can be managed nonoperatively. Endoscopic puncture of ureteroceles addresses most cases; iatrogenic reflux may rarely require secondary surgery. Robot-assisted laparoscopic upper pole nephroureterectomy and ureteroureterostomy procedures are rarely associated with complications.
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Affiliation(s)
- Hans G Pohl
- Urology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Urology, Children's National Hospital, 111 Michigan Avenue, NW, Suite WW-4400, Washington, DC 20010, USA.
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Wadham B, DeSilva A, Connolly T, Alshafei A, Keene D, Hennayake S. The place of retroperitoneoscopic hemi-nephroureterectomy for duplex kidney in children; risk of damage to the remnant moiety and strategies to reduce the risk. J Pediatr Urol 2021; 17:708.e1-708.e8. [PMID: 34454841 DOI: 10.1016/j.jpurol.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/18/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyse the outcomes of retroperitoneoscopic upper and lower moiety hemi-nephroureterectomy (HNU) and to assess the different variables that may have an impact on outcome; remnant moiety damage, morbidity and the need for secondary surgery. METHODS Prospectively recorded data of retroperitoneoscopic HNU's performed by a single surgeon from 2005 to 2018 were analysed. Patients were split into 2 groups according to moiety affected (UMHNU and LMHNU). Clinical presentation, underlying pathology, remnant moiety DRF on renal scintigraphy, and need for further surgery were recorded. Detailed operation notes were studied regards to renal vasculature, degree of dilatation, inflammatory changes and operative difficulties encountered. Renal loss was defined as remnant moiety DRF <10% post-operatively. Change in DRF was assessed regards to the moiety, pathology and age at surgery (<1 year, 1-2 years and ≥2 years). UMHNU group was further sub-divided into 3 subgroups: ureteroceles, ectopic ureters and 'other' pathology. Statistical analysis was performed using Fishers Exact test; findings were considered statistically significant at p < 0.05. RESULTS 78 operations met the inclusion criteria on 75 patients (3 bilateral). There were no conversions to open, and 67% were performed as day-case procedures (53/78 patients). In 91.2% (71/78) patients the procedure was definitive in resolving pathology and symptoms. 7 patients needed further procedures after HNU, 5 for ureterocele/ureteric stump. Overall, there was remnant moiety renal loss in 5.1% (4/78) patients, all with UM surgery (3 ectopic ureters and 1 ureterocele). All 4 operations were recorded prospectively as 'difficult operations' due to grossly dilated UM ureter/pelvis measuring >2 cm in diameter. 2 patients had a thinned out lower moiety (LM) sitting on top of the UM renal pelvis like a pancake with all vessels stretched over this dilated pelvis/ureter causing difficulty in accurate identification. There was intra-operative concern about some damage to LM vessels in 3 patients. Age <1year was also related to increased renal loss (2/8 patients <1 year, 1/25 patients 1-2 years, 1/45 patients ≥2 years of age P = 0.005). CONCLUSION Retroperitoneoscopic LMHNU is a safe and definitive procedure with rapid recovery and minimal scarring. UMHNU has higher rates of remnant moiety loss due to more complex renal pathology, but remains a safe, successful operation on the majority of patients. Renal damage was also related to age <1year (p = 0.005) and re-operation risk after UMHNU correlated to the presence of ureterocele (p = 0.003).
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Affiliation(s)
- Bianca Wadham
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK.
| | - Amila DeSilva
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - Thomas Connolly
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Abdulrahman Alshafei
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - David Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - Supul Hennayake
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
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Keene DJB, Subramaniam R. Duplex systems: Top-down or bottom-up approach? J Pediatr Urol 2020; 16:387.e1-387.e8. [PMID: 32340881 DOI: 10.1016/j.jpurol.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Duplex systems can be complicated by reflux, ureterocele, obstruction (most commonly PUJ in a lower moiety) and wetting secondary to an ectopic ureteric insertion in girls. The decision making algorithm for selection of surgical approach is complex and there is no consensus. The authors described the outcomes following an upper urinary tract approach in 2011(1) and now compare these results in a similar group of patients managed using a lower approach. OBJECTIVES To assess whether a top-down or bottom-up approach results in different likelihoods for further surgery. STUDY DESIGN A prospectively database was maintained for consecutive patients undergoing surgery for duplex systems by a single surgeon between 2003 and 2015. Patients were classified into 2 groups; Group 1 initial intention for upper urinary tract approach (heminephroureterectomy-HN) or Group 2 lower urinary tract approach (bladder reconstructive surgery-BRS). The requirement for further surgery was recorded-endoscopic incision (EI), bladder reconstructive surgery (BRS), endoscopic correction of reflux (ECR), heminephroureterectomy (HN). Indications for initial and subsequent surgery included urinary tract infection, VUJ obstruction and incontinence. Endoscopic incision was not performed for patients with an asymptomatic ureterocele. Statistical analysis consisted of Fisher's exact test with a 2 tail p value < 0.05 being statistically significant. RESULTS 79 patients underwent surgery for duplex systems. 39 patients had HN initially (Group 1) and 40 patients had BRS initially (Group 2). Further surgery was performed in 21% of patients from Group 1 (8 BRS) vs 5% of patients from Group 2 (1 redo BRS, 1 ECR). Significantly less additional surgical procedures were performed after BRS compared to HN (p = 0.048). The presence of both reflux and ureterocele increases the chances of further surgery in those patients who had HN initially compared to BRS (p = 0.01). No patients developed urinary retention or required intermittent catheterisation to improve bladder emptying. CONCLUSIONS Bladder reconstructive surgery (BRS) reduces the requirement for further surgery compared to heminephroureterectomy (HN) in symptomatic patients with a duplex kidney and either dilating vesicoureteric reflux or ureterocele.
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Affiliation(s)
- D J B Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - R Subramaniam
- Department of Paediatric Urology, Leeds General Infirmary, Leeds, LS1 3EX, UK.
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Harms M, Haid B, Schnabel MJ, Promm M, Roesch J, Oswald J, Rösch WH. Ureteroureterostomy in patients with duplex malformations: does a large diameter of the donor ureter affect the outcome? J Pediatr Urol 2019; 15:666.e1-666.e6. [PMID: 31672474 DOI: 10.1016/j.jpurol.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ureteroureterostomy is a commonly adopted, minimally invasive approach in the management of duplex anomalies requiring diversion, e.g., ectopic upper pole ureters. OBJECTIVE The authors hypothesized that a large diameter of the donor ureter could affect the outcome of this procedure. STUDY DESIGN Forty-two patients from two centers were retrospectively reviewed. To compare patients with small (group 1) vs large donor ureters (group 2), they were split at the median of the sonographically measured diameter at the level of the future anastomosis (n = 20 < 1.2 cm, mean 0.71 cm vs n = 22 ≥ 1.2 cm, mean 1.75 cm; P < 0.001) Figure. Ureteroureterostomy was performed in an end-to-side fashion with the donor ureter being tapered if required. RESULTS There was no significant difference in operation time (127 vs 121 min; P = 0.59) or duration of hospital stay (4.15 vs 4.09 days; P = 0.89) or number of postoperative complications (3 febrile urinary tract infections [fUTIs] in group 1 and one fUTI in group 2, P = 0.33). Reoperations during follow-up (1 stump resection and 2 endoscopic vesicoureteral reflux procedures) occurred exclusively in group 1 (P = 0.22). The mean pre-operative hydronephrosis grade of the affected moiety was higher in group 2 compared with group 1 (mean 2.73 Society for Fetal Urology classification [SFU] vs 1.65, P < 0.001). During follow-up, the mean hydronephrosis grade in group 2 improved from 2.73 to 1.36 SFU (P = 0.0011). In patients from group 1, the mean hydronephrosis grade remained relatively unchanged, from 1.65 to 1.35 SFU (P = 0.4). DISCUSSION After its first description in 1928, it took almost 40 years for ipsilateral ureteroureterostomy to become a widely adopted technique in the management of duplex malformations, especially for obstructive or ectopic upper pole moieties. Whereas it has been recently shown that the upper pole function does not seem to matter, there are still only narrative reports about the influence of the donor ureter diameter contributing to potential complications such as a de novo hydronephrosis of the receiving ureter with potential damage of the healthy moiety or the persistence of a pre-operatively marked hydronephrosis. While the study data are retrospective, the authors could demonstrate that a ureteral diameter of ≥1.2 cm is not factoring adversely into the occurrence of postoperative complications. CONCLUSION A donor ureter diameter ≥1.2 cm in ureteroureterostomy was not associated with a higher complication rate or worse outcome considering further fUTIs or reoperations. The postoperative reduction in hydronephrosis grade was more pronounced in patients with large donor ureters with disappearance of the pre-operative significant difference between the two groups.
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Affiliation(s)
- Mirjam Harms
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria.
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Marco J Schnabel
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center of Regensburg, Regensburg, Germany
| | - Martin Promm
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center of Regensburg, Regensburg, Germany
| | - Judith Roesch
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Josef Oswald
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Wolfgang H Rösch
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center of Regensburg, Regensburg, Germany
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Chen DX, Wang ZH, Wang SJ, Zhu YY, Li N, Wang XQ. Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report. World J Clin Cases 2019; 7:1169-1176. [PMID: 31183349 PMCID: PMC6547330 DOI: 10.12998/wjcc.v7.i10.1169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/16/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Renal duplication is a common deformity of the urinary system, with an incidence of approximately 1/125 in children. Symptomatic patients with hydronephrosis, vesicoureteral reflux, or incontinence may require surgical interventions. Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy.
CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney. Ultrasonography showed that the left kidney was larger, approximately 12.6 cm × 6.3 cm × 5.5 cm in size, with visible separation of the pelvis and an obviously separated lower portion. The upper segment of the left ureter was dilated (approximately 2.6 cm in width), and no significant dilation was observed in the middle and upper segments. The right kidney and ureter were normal. Primary diagnosis was left renal duplication malformation and hydronephrosis. Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed. Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney. The upper left kidney was smaller than normal, and the pelvis and ureter were larger than normal. The renal artery was blocked for 40 min. A hemolock was used to clamp down the kidney ureter, and a drainage tube was retained in the retroperitoneal cavity. The operation was uneventful, and the estimated amount of blood loss was 100 mL. Total abdominal drainage amount was 116 mL. The drainage tube was removed on postoperative day (POD) 3 and the patient was discharged on POD6. The pathological diagnosis confirmed the atrophy of the renal parenchyma, the dilation of the renal pelvis, hydronephrosis, and ureteral cystic dilation.
CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.
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Affiliation(s)
- Di-Xiang Chen
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Zi-Hao Wang
- The Fourth Military Medical University, Xi’an 710032, Shannxi Province, China
| | - Shan-Jie Wang
- The Sixth People’s Hospital of Jinan Affiliated to Jining Medical School, Jinan 250200, Shandong Province, China
| | - Yue-Yue Zhu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Nan Li
- Department of Ultrasound Diagnosis, PLA General Hospital, Beijing 100853, China
| | - Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
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MacDonald C, Small R, Flett M, Cascio S, O'Toole S. Predictors of complications following retroperitoneoscopic total and partial nephrectomy. J Pediatr Surg 2019; 54:331-334. [PMID: 30502005 DOI: 10.1016/j.jpedsurg.2018.10.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent reports in the literature suggest an increased risk of complications with retroperitoneal as opposed to transperitoneal approach to partial nephrectomy (PN) and total nephrectomy (TN). We are a large unit performing predominantly retroperitoneoscopic PN and TN. We aim to review our outcomes and perform analysis to elucidate the predictors of complications following the retroperitoneal approach for extirpative kidney surgery. METHODS We performed a single center retrospective review of children undergoing MIMS TN and PN between 2005 and 2015. Variables were tested for association with outcomes using Chi2 and Spearman's Rho correlation. RESULTS We performed 173 MIMS nephrectomies, 119 total and 54 partial. Median age and weight were 5 years (6 months to 18 years) and 24.9 kg (7.7 to 85 kg) and operative time 147 min. There were 4 conversions and 17 postoperative complications. 19.6% children required further surgery, including 8 completion stumpectomies. Retroperitoneal approach did not have increased risk compared to transperitoneal for need of further surgery. Partial nephrectomy was not associated with higher rate of intraoperative complication or LOS. Predictors of intraoperative complication were vessel closure technique. Associations with need for further surgery were: ESRF, contralateral disease, bladder dysfunction, presence of PD catheter, and need for concomitant procedure. CONCLUSION Our conversion rate (1.9%) and need for further surgery (13.1%) following the retroperitoneal approach to the kidney are favorable to the literature. Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Robert Small
- The Royal Hospital for Children, Glasgow, Scotland
| | - Martyn Flett
- The Royal Hospital for Children, Glasgow, Scotland
| | | | - Stuart O'Toole
- The Royal Hospital for Children, Glasgow, Scotland. Stuart.O'
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Polok M, Dzielendziak A, Apoznanski W, Patkowski D. Laparoscopic Heminephrectomy for Duplex Kidney in Children-The Learning Curve. Front Pediatr 2019; 7:117. [PMID: 31001503 PMCID: PMC6454101 DOI: 10.3389/fped.2019.00117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/11/2019] [Indexed: 01/28/2023] Open
Abstract
Objectives: Outcomes evolution during the learning curve of laparoscopic transperitoneal heminephrectomy in children with a duplex kidney. Materials and Methods: The data of 33 children, operated on between 2008 and 2017, with complicated duplex kidney, were subjected to a retrospective analysis. All patients were operated on by transperitoneal access using the laparoscopic technique. Patients were divided into two groups (1: subsequent operation 1-16, and 2: operations 17-33) to evaluate the learning curve. Results: There was no need for conversion. Total complications occurred in seven patients in Group 1 and 2 patients of Group 2 (p < 0.05). Two patients (6%) (both upper pole heminephrectomies) required reoperation to remove the ureter stump because of recurrent UTIs due to undiagnosed VUR to the stump (1 from each of Groups 1 and 2). Prolonged urine leakage (over 4 days) was observed in four patients (12%; all from group 1); in three patients, conservative treatment was successful, while the placement of a DJ catheter was needed in the fourth. A significant decrease of kidney function (>6%) in scintigraphy was observed in two of the 15 patients after the surgery. The time of surgery decreased from 140 (range 85-185) min in Group 1 to 125 (range 100-150) min in Group 2 (p < 0.05). Conclusions: Laparoscopic heminephrectomy is connected to the learning curve. Most complications occurred in the first 16 operations. With increasing experience, the time of operation decreased. In patients with reflux to the upper pole, referred for upper pole heminephrectomy, it is necessary to consider the removal of the ureter to the level of the vesicoureteral junction.
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Affiliation(s)
- Marcin Polok
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Dzielendziak
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Apoznanski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
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Sheth KR, White JT, Janzen N, Koh CJ, Austin PF, Roth DR, Tu DD, Mittal A, Wang MH, Gonzales ET, Jorgez C, Seth A. Evaluating Outcomes of Differential Surgical Management of Nonfunctioning Upper Pole Renal Moieties in Duplex Collecting Systems. Urology 2018; 123:198-203. [PMID: 30031832 DOI: 10.1016/j.urology.2018.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/08/2018] [Accepted: 06/17/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the management and clinical outcomes of nonfunctioning upper pole moieties treated with either upper pole heminephrectomy or upper pole preservation with lower ureteral reconstruction at a single tertiary institution. METHODS After Institutional Review Board (IRB) approval, patients with duplicated systems undergoing upper pole heminephrectomy, ureteroureterostomy, or common sheath ureteral reimplantation from 2012-2017 were identified. Only patients with a nonfunctioning upper pole moiety on ultrasound or renal scan were included. Patients undergoing upper pole heminephrectomy were compared to those undergoing upper pole preservation with respect to demographics, anatomic variations preoperatively, and postoperative outcomes. RESULTS Twenty-seven (57%) patients underwent upper pole preservation with lower ureteral reconstruction; 20 (43%) patients underwent upper pole heminephrectomy. Patients undergoing lower ureteral reconstruction were older (1.63 vs 2.76 years, P = .018) and more commonly presented with lower pole vesicoureteral reflux (67% vs 25%, P = .008). No significant difference in postoperative complications was seen between the two groups. After ureteroureterostomy, one patient developed new onset symptomatic reflux to the upper pole requiring intravesical reimplantation. In the heminephrectomy group, 4 of 11 patients with ureteroceles had ureterocelectomy with concomitant lower pole reimplantation. After heminephrectomy, two additional patients required further interventions: ureterocele excision and transurethral polyp excision. CONCLUSION For patients with nonfunctional upper poles, lower tract reconstruction is a safe alternative to upper pole heminephrectomy. No significant difference in outcomes was seen. Considering that nearly 1 of 3 of patients with upper pole heminephrectomy required additional lower urinary tract procedures, pursuing upper pole preservation with lower urinary tract reconstruction may be favorable.
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Affiliation(s)
- Kunj R Sheth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jeffrey T White
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nicolette Janzen
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Chester J Koh
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Paul F Austin
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - David R Roth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Duong D Tu
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Angela Mittal
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Ming-Hsien Wang
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Edmond T Gonzales
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Carolina Jorgez
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Abhishek Seth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Aydogdu I, Silay MS. Transperitoneal laparoscopic heminephroureterectomy in pediatric population: A single-centre experience using a sealing device. Can Urol Assoc J 2018; 12:E409-E414. [PMID: 29787375 DOI: 10.5489/cuaj.4992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We sought to report the outcomes of transperitoneal laparoscopic heminephroureterectomy (LHNU) in pediatric population and to describe the technical details of this minimally invasive surgery. METHODS Seventeen pediatric patients (18 renal units), who had consecutive transperitoneal LHNU in our department between January 2012 and July 2017 were included in the study. In all patients, diagnostic cystoscopy and retrograde pyelography were carried out immediately before the operation. A catheter was inserted in the unaffected ureter and fixed. LHNU with a transperitoneal approach was carried out in all patients with the aid of LigaSure®. After removal of the specimen, the intervention was finalized with the insertion of a drain. All intraoperative and postoperative data of the patients were recorded prospectively. RESULTS The average age of the patients was 55.9±35.8 months (range 8-121). The average duration of the operations was 121.7±24.0 minutes (range 100-200). The average hospitalization time was 1.6±0.4 days (range 1-2). No intraoperative complication occurred in our patients. The average followup period was 29.1±13.4 months (range 4-48). During the followup period, no complications were observed except one patient who had pyelonephritis within the first month of surgery. CONCLUSIONS Transperitoneal LHNU is a minimally invasive method that can be used safely in pediatric patients. Using a standardized technique during the procedure is critical to increase the success and decrease the complication rates.
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Affiliation(s)
- Ibrahim Aydogdu
- Bezmialem Vakif University, Faculty of Medicine, Department of Pediatric Surgery
| | - Mesrur Selcuk Silay
- Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Urology; Istanbul, Turkey
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Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters. Curr Urol Rep 2017; 18:21. [DOI: 10.1007/s11934-017-0664-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Esposito C, Escolino M, Troncoso Solar B, Iacona R, Esposito R, Settimi A, Mushtaq I. Diagnosis and long-term outcome of renal cysts after laparoscopic partial nephrectomy in children. BJU Int 2016; 119:761-766. [DOI: 10.1111/bju.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Maria Escolino
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | | | - Roberta Iacona
- Department of Paediatric Surgery; Great Ormond Street Hospital; London UK
| | - Rosanna Esposito
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Alessandro Settimi
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Imran Mushtaq
- Department of Paediatric Surgery; Great Ormond Street Hospital; London UK
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Esposito C, Escolino M, Castagnetti M, Savanelli A, La Manna A, Farina A, Turrà F, Roberti A, Settimi A, Varlet F, Till H, Valla JS. Retroperitoneal and laparoscopic heminephrectomy in duplex kidney in infants and children. Transl Pediatr 2016; 5:245-250. [PMID: 27867847 PMCID: PMC5107369 DOI: 10.21037/tp.2016.09.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Two main techniques are adopted to perform partial nephrectomy in children: laparoscopy and retroperitoneoscopy. The aim of this paper is to review the larger multicentric experience recently published by our group to review indications, techniques and results of both approaches. METHODS Data of 102 patients underwent partial nephrectomy in a 5-year period using minimally invasive surgery (MIS) procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ2 test and Student's t-test. RESULTS The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) (χ2 =0.05). In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stump (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN: 166.2 min vs. RPN: 255 min; P<0.001) and hospitalization (LPN: 3.5 days vs. RPN: 4.1 days; P<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. CONCLUSIONS MIS now represents the gold standard technique to perform partial nephrectomy in children with duplex kidney. Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | | | - Antonio Savanelli
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Angela La Manna
- Pediatric Nephrology Unit, Second University of Naples, Naples, Italy
| | - Alessandra Farina
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Agnese Roberti
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | | | - Francois Varlet
- Pediatric Surgery Unit, St Etienne Hospital, St Etienne, France
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Joyeux L, Lacreuse I, Schneider A, Moog R, Borgnon J, Lopez M, Varlet F, Becmeur F, Sapin E. Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study. Surg Endosc 2016; 31:1241-1249. [DOI: 10.1007/s00464-016-5098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
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Strine AC, Whittam BM, Misseri R, Kaefer M, Rink RC, Karmazyn B, Cain MP. Is renal scintigraphy necessary after heminephrectomy in children? J Pediatr Urol 2016; 12:38.e1-4. [PMID: 26279101 DOI: 10.1016/j.jpurol.2015.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heminephrectomy remains an excellent option for a poorly functioning moiety in a duplicated collecting system. A primary concern during heminephrectomy is the potential for a significant functional loss in the remaining ipsilateral moiety. As the gold standard for the assessment of differential renal function, renal scintigraphy is often used in the postoperative evaluation of children undergoing heminephrectomy. However, this imaging modality is costly, invasive, and associated with exposure to radiation. Doppler renal ultrasound (RUS) avoids these concerns and is able to evaluate for structural and functional abnormalities. OBJECTIVE The present study sought to compare Doppler RUS to renal scintigraphy in determining the viability of the remaining ipsilateral moiety in children who underwent heminephrectomy for a poorly functioning moiety in a duplicated collecting system. MATERIALS AND METHODS The institutional database of children who underwent open heminephrectomy for a poorly functioning moiety in a duplicated collecting system between 2006 and 2013 was reviewed. Only children who underwent both a postoperative Doppler RUS and renal scan were included. A blinded pediatric radiologist independently reviewed all Doppler RUS. Vascular flow on Doppler RUS was correlated with the preservation of renal function in the remaining ipsilateral moiety on renal scintigraphy. RESULTS A total of 29 children were identified for inclusion. Demographic and operative data are provided in Table. The average pre-operative and postoperative differential renal function in the ipsilateral kidney was 41.6% and 38% on renal scintigraphy, respectively, for an average decrease of 3.6% (-18% to +12%). Doppler RUS demonstrated the presence of vascular flow to the remaining ipsilateral moieties of all children after heminephrectomy. Renal scintigraphy confirmed the viability of these moieties in all children. DISCUSSION The first study comparing Doppler RUS to renal scintigraphy was performed to determine the viability of the remaining ipsilateral moiety after heminephrectomy. While no cases of complete functional loss were observed, an average decrease of 3.6% in the ipsilateral renal function favorably compared with other series of children undergoing open heminephrectomy. The limitations of the study included its retrospective design at a single institution. The interpretation of Doppler RUS by an individual pediatric radiologist may also have lead to interobserver variability and impacted the reproducibility of the study, while the absence of any cases of complete functional loss may have impacted its generalizability. CONCLUSIONS Doppler RUS is an accurate imaging modality for determining the viability of the remaining ipsilateral moiety after heminephrectomy and may obviate the need for renal scintigraphy.
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Affiliation(s)
- A C Strine
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - B M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - R Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - R C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - B Karmazyn
- Section of Pediatric Radiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Esposito C, Escolino M, Miyano G, Caione P, Chiarenza F, Riccipetitoni G, Yamataka A, Savanelli A, Settimi A, Varlet F, Patkowski D, Cerulo M, Castagnetti M, Till H, Marotta R, La Manna A, Valla JS. A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey. World J Urol 2015; 34:939-48. [PMID: 26577623 DOI: 10.1007/s00345-015-1728-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/03/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys. METHODS Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ (2) test and Student's t test. RESULTS The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ (2) = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. CONCLUSIONS Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Maria Escolino
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Paolo Caione
- Department of Pediatric Urology, Bambino Gesù Hospital, Rome, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | | | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Antonio Savanelli
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Francois Varlet
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France
| | - Dariusz Patkowski
- Department of Pediatric Surgery, Wroclaw University, Wroclaw, Poland
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | | | - Holger Till
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
| | - Rosaria Marotta
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela La Manna
- Department of Pediatrics, Second University of Naples, Naples, Italy
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Marte A, Papparella A, Pintozzi L. Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience. Afr J Paediatr Surg 2015; 12:227-31. [PMID: 26712285 PMCID: PMC4955480 DOI: 10.4103/0189-6725.172546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN) in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal approach. Here, we report our experience using a TP approach. MATERIALS AND METHODS From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9). Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI) and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN); identification of the kidney (detachment of the colon); isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain. RESULTS The mean operative time was 154 min (range: 81-220 min). All patients were discharged from the 2 nd to 4 th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously. CONCLUSION The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.
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Affiliation(s)
- Antonio Marte
- Department Pediatric Surgery, Second University of Naples, Largo Madonna delle Grazie 1, Naples 80138, Italy
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Malik RD, Pariser JJ, Gundeti MS. Outcomes in Pediatric Robot-Assisted Laparoscopic Heminephrectomy Compared with Contemporary Open and Laparoscopic Series. J Endourol 2015; 29:1346-52. [PMID: 25790273 DOI: 10.1089/end.2014.0818] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To compare our renal and clinical outcomes for robot-assisted laparoscopic heminephrectomy (RAL-HN) in the pediatric population with duplicated systems with those of current contemporary open and laparoscopic series. PATIENTS AND METHODS Sixteen children underwent RAL-HN from 2009 to 2014. Data were collected via retrospective chart review including demographics, preoperative and postoperative imaging, operative time, estimated blood loss (EBL), length of stay (LOS), complications, and renal outcomes. RESULTS Mean age at surgery was 37.5±49.2 months. Mean operative time was 135±36 minutes with an EBL of 10±5 mL. Mean LOS was 2±0.8 days, and no major perioperative complications were observed. Mean follow-up was 22.1±17.2 months. Two patients needed secondary ureterectomy for recurrent urinary tract infection in the setting of a refluxing ureteral stump. One of these patients also underwent a ureteral reimplantation of the ipsilateral normal ureter. No patients lost their remaining healthy moiety. Asymptomatic cyst formation was seen in four (25%) patients, and self- limited postoperative urinoma was seen in 2 (13%) patients. Postoperative perinephric abscess did not develop in any patient. Mean change in renal function based on nuclear renography of the duplex kidney was -2.7%±4.6%. CONCLUSIONS Compared with previously published literature evaluating open and laparoscopic heminephrectomy, RAL-HN provides comparable outcomes in regard to complication rate and renal function of the remnant moiety.
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Affiliation(s)
- Rena D Malik
- Department of Surgery, Section of Urology, The University of Chicago Medicine & Biological Sciences , Chicago, Illinois
| | - Joseph J Pariser
- Department of Surgery, Section of Urology, The University of Chicago Medicine & Biological Sciences , Chicago, Illinois
| | - Mohan S Gundeti
- Department of Surgery, Section of Urology, The University of Chicago Medicine & Biological Sciences , Chicago, Illinois
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Esposito C, Varlet F, Patkowski D, Castagnetti M, Escolino M, Draghici IM, Settimi A, Savanelli A, Till H. Laparoscopic partial nephrectomy in duplex kidneys in infants and children: results of an European multicentric survey. Surg Endosc 2015; 29:3469-76. [DOI: 10.1007/s00464-015-4096-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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Complications After Common Sheath Reimplantation in Pediatric Patients With Complicated Duplex System. Urology 2015; 85:457-62. [DOI: 10.1016/j.urology.2014.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/22/2022]
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Timberlake MD, Corbett ST. Minimally Invasive Techniques for Management of the Ureterocele and Ectopic Ureter. Urol Clin North Am 2015; 42:61-76. [DOI: 10.1016/j.ucl.2014.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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McLeod DJ, Alpert SA, Ural Z, Jayanthi VR. Ureteroureterostomy irrespective of ureteral size or upper pole function: a single center experience. J Pediatr Urol 2014; 10:616-9. [PMID: 24947344 DOI: 10.1016/j.jpurol.2014.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although ureteroureterostomy (UU) is an established procedure for the treatment of duplex anomalies, there may be a reluctance to apply this approach to patients with poor upper pole function and/or marked degrees of ureteral dilation. METHODS An institutional review board (IRB)-approved retrospective analysis of all patients undergoing UU between 2006 and present was performed. All patients underwent an end-to-side anastomosis with a double-J stent left in the lower pole ureter. Laparoscopic repairs were done 'high' and open repairs were done 'low'. If the upper pole ureter remained massively dilated after transection, the ureter was partially closed to reduce the length of the anastomosis. Data collected included demographics, diagnosis, surgical interventions, imaging studies and outcomes. RESULTS A total of 41 patients (43 renal units) were identified. There were 35 females and six males with an average age at surgery of 2.3 years (range 55 days to 15.9 years) and an average follow up of 2.8 years. Diagnosis included ureterocele (17), ectopic duplex ureter (25) and ureteral triplication (1). Thirty-six patients underwent UU only and five underwent UU with simultaneous lower pole reimplantation. Twelve of the 41 patients (29%) underwent laparoscopic repair. Twelve of the 43 renal units (28%) required ureteral tapering, of which three were performed laparoscopically. Preoperative median upper pole function was 17% (0-35%). Six patients had no measurable function and ten had < 15%. No patient developed lower pole hydronephrosis in the follow-up period. There were two complications: one patient was found to have a post-operative ureterovesical junction (UVJ) stricture and the second had an anastomotic stricture. CONCLUSION Ureteroureterostomy is a safe and effective technique for the reconstruction of duplex anomalies, even with a massively dilated and poorly functioning upper pole moiety. With no identifiable negative effect on the lower pole system, the concept of automatically removing 'dysplastic' upper pole segments can be challenged.
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Affiliation(s)
- D J McLeod
- Nationwide Children's Hospital, Division of Pediatric Urology and The Ohio State University Medical Center, Timken Hall, G280, 700 Children's Drive, Columbus, OH 43205, USA.
| | - S A Alpert
- Nationwide Children's Hospital, Division of Pediatric Urology and The Ohio State University Medical Center, Timken Hall, G280, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Z Ural
- Nationwide Children's Hospital, Division of Pediatric Urology and The Ohio State University Medical Center, Timken Hall, G280, 700 Children's Drive, Columbus, OH 43205, USA.
| | - V R Jayanthi
- Nationwide Children's Hospital, Division of Pediatric Urology and The Ohio State University Medical Center, Timken Hall, G280, 700 Children's Drive, Columbus, OH 43205, USA.
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Robotic-assisted partial nephrectomy in duplicated collecting systems in the pediatric population: techniques and outcomes. J Pediatr Urol 2014; 10:374-9. [PMID: 24268881 DOI: 10.1016/j.jpurol.2013.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/16/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We present our experience with pediatric robotic-assisted laparoscopic partial nephrectomy of a nonfunctioning moiety in a duplicated system (RALPN), comparing techniques and outcomes with those previously reported in the literature. To our knowledge, this is the largest series of this surgical procedure to date. PATIENTS AND METHODS We retrospectively reviewed all pediatric patients at our institution that had undergone RALPN from 2006 to 2012. RESULTS Twenty-one patients underwent RALPN between 2006 and 2012. Mean patient age was 4.1 years. Mean operative time was 301 min. Mean estimated blood loss was 36 ml. Mean length of stay was 38 h. The majority of cases were performed with three laparoscopic ports. At initial follow-up ultrasound 6/21 (29%) demonstrated a fluid collection. The majority of these collections occurred in cases where the resection defect was not closed intraoperatively (42% of cases vs. 11% of cases). All fluid collections were asymptomatic and managed conservatively. CONCLUSION RALPN is associated with low complication rates. The robotic system allows for the use of only two small robotic working ports in most cases. Postoperative fluid collections may be prevented by formal closure of the polar defect, but fluid collections that do occur can be followed conservatively.
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Cabezali D, Maruszewski P, López F, Aransay A, Gomez A. Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol 2013; 27:133-8. [PMID: 23005915 DOI: 10.1089/end.2012.0379] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We report our experience with laparoscopic heminephrectomy (LH) in children with duplex kidneys, emphasizing complications and late outcomes, and including anatomic and functional aspects. PATIENTS AND METHODS We retrospectively reviewed medical data of 28 children with a duplex kidney who underwent LH. Complications were evaluated according to the Savata and Clavien classiffication systems. RESULTS Nineteen upper (67.8%) and 9 (32.1%) lower moieties were removed. All laparoscopic procedures were completed as planned without conversion. There were three (10.5%) cases of intraoperative bleeding successfully controlled by compression with gauze. Complications after surgery included two urinomas (7%), one intra-abdominal hematoma (3.5%), and two cases of complete functional loss (7%) because of torsion of the remnant upper pole. In six (21.4%) cases, a cyst at the resection margin of the kidney remnant was found. The function of the remnant pole was preserved in 23 (82.1%) cases and decreased in approximately 5% in 3 (10.5%). CONCLUSIONS The anatomic and functional outcomes of LH must be evaluated with imaging studies and nuclear scintigraphy to rule out structural abnormalities and functional impairment. An extensive dissection in the lower pole LH can lead to the upper moiety torsion after surgery.
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Affiliation(s)
- Daniel Cabezali
- Department of Pediatric Urology, Hospital 12 Octubre, Madrid, Spain.
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Feasibility and Safety of Laparoscopic Ablative Renal Surgery in Infants: Comparative Study with Children. J Urol 2012; 188:1330-4. [DOI: 10.1016/j.juro.2012.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Indexed: 11/17/2022]
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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