Laparoscopic management and outcomes in non-functioning moieties of duplex kidneys in children

Abstract

Retroperitoneal laparoscopic hemi-nephrectomy (RLHN) is a well tolerated, minimally invasive, although technically demanding, procedure for children with a non-functioning moiety in a duplex kidney. There is very little published data on the long-term follow up of such patients. We collected data to assess outcomes from our experience. Data were retrospectively gathered on all patients who underwent RLHN at our institution between February 2003 and July 2008. Follow-up ultrasounds were obtained in all patients. RLHN was performed in 42 patients. All had a non-functioning moiety of a duplex kidney and in addition recurrent urinary tract infections (n=36), incontinence (n=5) or vesico-ureteric reflux (n=1). Median age at surgery was 3 years, 7 months (4 months-13 years, 10 months). One patient required conversion to open procedure due to low (pelvic) kidney. The median operating time was 90min (45-150min). Urine leak developed postoperatively in one patient and loss of function of the remaining moiety occurred in another patient. They were followed up for a median period of 11 months (1-51 months). RLHN is a feasible and safe technique for the experienced paediatric laparoscopic urologist. Results compare very favourably with open heminephrectomy in terms of operating time and outcomes. Long-term follow up is mandatory.