PURPOSE: Laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) associated with horseshoe kidney (HSK) is already described in adults but seldom in young children.
We describe our monocenteric experience in 10 children treated successfully with laparoscopic dismembered pyeloplasty.
MATERIAL AND METHODS: Between 2002 and 2012, 8 boys and 2 girls, (mean age 8 years (0.7-16.5)) had a laparoscopic dismembered pyeloplasty for UPJO associated with HSK. Presenting symptoms were abdominal pain (n=3), urinary tract infection (n=2), abdominal mass (n=1), hematuria (n=1). The diagnosis of HSK was done preoperatively in all cases but one. The anastomosis was done by running or interrupted 5/0 or 6/0 resorbable sutures and drained by JJ-stent.
RESULTS: Laparoscopic dismembered pyeloplasty was feasible in all cases. Mean operating time was 220 min (180 -260). Anatomical anomalies included vessels crossing anteriorly the UPJ in 6 cases (polar vessels n=4, UPJ posterior to an abnormal branch of vena cava n=1 and renal vein n=1), and 4 high ureteral insertion.. Two children had an extensive reduction pyeloplasty. The mean hospital stay was 3.2 (1-8). Mean follow-up is 50 months (4-132). All patients are asymptomatic with significant improvement of their dilatation.
CONCLUSIONS: The transperitoneal laparoscopic approach is adapted for pyeloplasty in children with HSK. It allows a global exploration of the upper tract and efficient identification of the anatomical anomalies specially crossing vessels. Although our series is limited in number, it is the first description specific to HSK in children and shows that this approach is a lasting effective in young children.
Written by:
Blanc T, Koulouris E, Botto N, Paye-Jaouen A, El-Ghoneimi A. Are you the author?
Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité. 48 Bd Sérurier 75935 Paris Cedex 19, FRANCE.
Reference: J Urol. 2013 Oct 16. pii: S0022-5347(13)05672-3.
doi: 10.1016/j.juro.2013.10.059
PubMed Abstract
PMID: 24140844
UroToday.com Endourology Section
