Laparoscopic ipsilateral uretero-ureterostomy in infants and children for duplication anomalies of the urinary tract

Abstract

Purpose To report the feasibility of laparoscopic ipsilateral uretero-ureterostomy (LIUU) for duplication anomalies of the urinary tract in infants and children and the short term results in six patients. Material and methods LIUU was performed transperitoneally with 3 to 4 ports for unilateral and bilateral cases respectively. Cystoscopy, retrograde pyelogram and stent placement in the recipient ureter was performed at the beginning of the case. The anastomosis was carried out with running or interrupted 6-0 sutures. An abdominal drain and Foley catheter were left indwelling in all cases. Demographic data, body measurements, type of procedure and indication, laterality, intra and postoperative complications, analgesia requirement, length of hospitalization and outcome were recorded. Results There were 8 LIUU in 6 patients (2 males and 4 females). Mean age was 51 months. Diagnoses were bilateral lower pole vesicoureteral reflux in 2 cases and ectopic ureter in 6 cases. Mean operative time including cystoscopy was 257 minutes (range 140-430) and estimated blood loss 3 ml. There were no intraoperative complications. Mean morphine requirement was 0.13 mg/kg. Two patients needed acetaminophen only for pain management. All patients were discharged with no narcotics at median of 3 days (range 1-7). There were 2 postoperative febrile urinary tract infections. Follow up renal ultrasound demonstrated no significant hydronephrosis of the moieties involved. Conclusions In this initial experience LIUU was done safely and effectively even in the small infants. Postoperative course was uneventful with negligible blood loss and minimal analgesia requirement with initial results comparable to those of open surgery