Indications for the anterior extraperitoneal approach in pediatric urologic surgery: The Chicago experience

Abstract

Abstract Introduction: The usefulness of the anterior extraperitoneal surgical approach is recognized for adult donor and radical nephrectomy. As this technique has not received wide pediatric examination, we report our experience with this procedure and present usage guidelines. Methods: Between 1999 and 2003, patients underwent surgery at our institution via an anterior extraperitoneal incision when there was atypical renal anatomy or planned simultaneous renal and lower ureteral surgery. Results: The anterior extraperitoneal approach was successfully used in ten patients (11 kidneys) between the ages of 2 months and 15 years. Six patients underwent pyeloplasties for ureteropelvic junction (UPJ) obstruction in kidneys with additional anatomical considerations (# cases): ptotic kidney (1), horseshoe kidney (2), crossed fused ectopia (1), redo pyeloplasty (1), and multiple renal calculi mandating nephrostolithotomy (1). Two patients had urinary undiversions and one had a nephroureterectomy for an ectopic ureter to the prostate. Another patient with end-stage renal disease and refractory hypertension underwent bilateral nephrectomies via bilateral incisions to leave the peritoneum intact for future renal transplantation. All procedures were performed without complications and the surgical exposure was excellent in all cases. The surgical exposure likely would have been restricted if a traditional flank incision had been done in these cases. Conclusions: We recommend the anterior extraperitoneal approach for pediatric renal surgery if exposure of anomalous renal anatomy would be restricted by traditional flank surgery. Also, access to both kidneys can be obtained with bilateral incisions without violating the peritoneal cavity.