Laparoscopic treatment of hydronephrosis in children with the horseshoe kidney: description of a case series

Abstract

Introduction. The present research is a case series of laparoscopic treatment of pyeloureteral obstruction in 3 patients with a horseshoe kidney.
 Material and methods. Laparoscopic treatment of hydronephrosis in three patients with the horseshoe kidney was performed by one surgeon (2 boys, 1 girl). Preoperative computed tomography confirmed the diagnosis and found a source of hydronephrosis – obstruction of the pyeloureteral segment. At laparoscopy, the horseshoe kidney anatomy was finally defined and the cause of the obstruction of the pyeloureteral segment was found too - high ureteral transposition from the pelvis or an aberrant vessel. Pyeloplasty performed by Anderson-Hynes technique was a final stage of the treatment.
 Results. The lesion of the left kidney half was noted in 2 cases, of the right one – in 1 case. All three interventions were successfully performed laparoscopically without conversion to open surgery. Duration of surgical intervention varied from 60 to 90 minutes. Mean operative time was 75.0±15.0 min (median – 75.0 [67.5; 82.5] min). Average stay in ICU was 19.3±4.2 hours (median – 18.0 [17.0; 21.0] hours) with the longest interval being 24 hours in a younger patient due to tracheal decannulation problems .
 The anteroposterior diameter of the pelvis was measured before surgery and 6 months after surgery. It was found that all patients had reduction in the pelvis size in average from 43.3±11.5 mm to 8.0±2.0 mm (median – 50.0 [40.0; 50.0] mm and 8.0 [7.0; 9.0] mm, respectively). Patients also showed a positive trend in the restoration of blood flow in the affected segment of the kidney. Resistance index changes were in averaged from 0.70±0.02 to 0.62±0.02 (median – 0.71 [0.70; 0.72] and 0.62 [0.61; 0.63], respectively).
 Conclusion. Surgical treatment of hydronephrosis in patients with the horseshoe kidney is a complex problem, mainly because of the altered renal anatomy and variety of triggers that may cause hydronephrosis. Laparoscopic pyeloplasty is obviously a universal way to treat the discussed pathology.