[Treatment of ureterocele in ureteral duplication: upper pole nephro-ureterectomy by retroperitoneoscopy in children: 24 cases].
ABSTRACT The objective of this study is to present the results of 24 upper pole nephrectomies performed by retroperitoneoscopy in children between 1995 and 2000.
This series of 24 children consisted of 15 girls and 9 boys with a mean age of 22 months. The patient was placed in the lateral supine position and 3 to 4 trocars were inserted. Parenchymal section was performed by ultrasound or unipolar scalpel.
Three cases (12.5%) required open conversion. Nine intraoperative complications (37%) were observed and repaired intraoperatively. Five postoperative complications (20%) consisted of residual perirenal collections, requiring drainage under anaesthesia in only one case. The mean operating time was 2 hours 40 minutes. The mean hospital stay was 3.4 days. The mean follow-up was 32 months. No cases of secondary atrophy of the lower pole were observed.
Overall, these preliminary results are comparable to those of conventional open surgery. The advantage of this method is a reduction of skin and musculo-aponeurotic scars.
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ABSTRACT: Laparoscopy has raised great interest in the past few years in the field of pediatric urology. It has evolved from a simple diagnostic maneuver to complex operative procedures. The aim of this study was to review urologic laparoscopy literature and provide a critical review of this field to establish current indications for videosurgery in pediatric urology. In general, from an anatomic point of view, retroperitoneoscopy seems to be more suitable than the transperitoneal laparoscopic approach for reaching the upper urinary tract. It also is less invasive and complies with the criteria for open renal surgery. With respect to current indications for videosurgery in pediatric urology, the authors have identified several well-established clinical procedures, although no large series have been published for any of the procedures, except for the treatment of varicocele, nonpalpable testis, and nephrectomy. In conclusion, the data reviewed suggest that videosurgery is a safe and feasible technique in pediatric urology if performed by expert surgeons, and that it certainly will develop further in the next few years.Surgical Endoscopy 12/2004; 18(11):1559-64. DOI:10.1007/s00464-003-8272-0 · 3.31 Impact Factor
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ABSTRACT: To evaluate outcomes following laparoscopic heminephrectomy (LHN) in duplex kidneys in the pediatric population, focusing on the fate of the remnant moiety. 142 patients underwent laparoscopic heminephrectomy for duplex kidney across 4 different institutions in the U.S. and Europe. Median age at surgery was 11.4 months. A retroperitoneoscopic approach was used in all patients, with 82 (57.7%) patients placed in posterior prone position (PPR), and 60 (42.3%) in lateral retroperitoneal (LRP). Follow up included routine ultrasound, and DMSA was performed in the event of abnormalities in ultrasound or postoperative course. Median operative time was 120 min. 11 patients (7.7%) required open conversion, the majority of which (8/11) occurred prior to 2000. Median hospital stay was 2 days and no major complications were observed. 7 patients (4.9%) developed a postoperative urinoma, and 1 patient required ureterectomy for urinary tract infection. With a median follow-up of 4.5 years, 7 children (4.9%) experienced significant loss of function in the remaining moiety, with 3 patients requiring completion nephrectomy. Of patients losing their remaining moiety, median age at surgery was 9 months [4 - 42], and all except 1 (6/7) had an upper pole heminephrectomy. Three patients in this group (42%) experienced an immediate postoperative complication (hematoma, UTI, urinoma). No consistent preoperative or technical factors were consistent in the renal loss group. LHN for duplex kidney produces satisfactory outcomes in the pediatric population. With a median follow up of 4.5 years, we demonstrate a non-functioning renal moiety rate of 5%. We did not identify any clinical predictors of this outcome in our series, although upper pole heminephrectomy, patient age, and postoperative complications may be contributing factors.Journal of pediatric urology 06/2011; 7(3):272-5. DOI:10.1016/j.jpurol.2011.02.029 · 1.38 Impact Factor