MINIMALLY INVASIVE TREATMENT OF OBSTRUCTIONS OF THE PYELOURETERAL SEGMENT IN NEONATES AND INFANTS. STATE OF THE ART

Abstract

Introduction. The obstruction of pyeloureteral junction is the most common cause of hydronephrosis in neonates and infants. Indications for surgical treatment include: decrease in differentiated renal function less than 40%, continued decrease in differentiated renal function for more than 10% in subsequent examinations, poor excretory function at diuretic renography (T ½ more than 20 min), increase in the anteroposterior diameter of the pelvis over 20 mm or dilatation of degrees III and IV by the classification of the Society of Fetal Urology (SFU). Material and methods. Treatment options for this condition include a wide range of approaches - from active observation to minimally invasive methods, including laparoscopic or robotic pyeloplasty. The main goal of treatment is to alleviate symptoms as well as to improve and / or to maintain renal function. The most common technique for removing obstruction of the pyeloureteral junction is dismembered pyeloplasty which is also called Anderson-Hynes operation. The Anderson-Hynes laparoscopic pyeloplasty is not widely spread what reflects the complex nature of this surgery in newborns and infants. A surgical access aiming to provide a minimally invasive correction of the obstruction in the pelvic-ureteric junction can be achieved equally by laparoscopic pyeloplasty, retroperitoneoscopicpyeloplasty and robot-assisted laparoscopic pyeloplasty. Results. Currently, there is a limited number of reports on the application of laparoscopic techniques for treating pyeloureteral segment obstructions in newborns and infants. The reasonability of such an approach in children under one year of age remains a matter of debate. It has been found out that postoperative results after laparoscopy are similar to those after a conventional open intervention. Conclusion. This literature review demonstrates that a surgeon - before performing reconstructive operations on infant’s kidneys must have a good experience in many other advanced laparoscopic procedures with endosurgical suturing . Laparoscopy offers many more benefits than simply reducing the patient’s hospital stay or less drug use. The magnification inherent to high-definition (HD) or ultra-high-resolution television (UHD or 4K) technology makes these surgical interventions more accurate due to better visualization of such microobjects and their layers at the baby’s ureter, which has a diameter slightly exceeding 2 mm. Another advantage of laparoscopy lies in more adequate assessment of the situation in case of hydronephrosis than that in the open surgery.