Laparoscopic Ureterocutaneostomy for Urinary Diversion in Selected Infants

Abstract

Primary surgical correction has obviated the need for urinary diversion in many fields of pediatric obstructive and refluxive uropathy. However, a small number of children are not suitable for primary surgical correction and require temporary diversion. We present a small series of infants who underwent minimally invasive ureterocutaneostomy. Four infants (age 1-13 months) underwent laparoscopic ureterocutaneostomy. The indication for urinary diversion was a primary obstructive megaureter in 2 patients, deterioration of kidney function due to a posterior urethral valve in 1, and refluxive uropathy of a dysplastic single kidney in another. Laparoscopic ureteral diversion was performed using a 3 trocar technique. In 3 patients, both ureters were identified above the crossing of the iliac vessels and exteriorized through the right and left trocar incision respectively. A loop ureterocutaneostomy was performed in 3, and an end ureterocutaneostomy in 1 patient. Laparoscopic ureterocutaneostomy was feasible and there were no complications in any of the infants. The mean duration of operation was 111 minutes (range 85 to 145). Isotope renography after a mean follow-up of 11 months (range 2 to 16) revealed improved renal drainage in 3 infants, while 1 required kidney transplantation due to progressive renal insufficiency. Laparoscopic ureterocutaneostomy in infants is feasible. It may be considered in a selected group of patients with obstructive or refluxive uropathy in whom urinary diversion is required.