Pediatric Laparoscopic Nephroureterectomy in Complicated Urinary Tract Anomalies

Abstract

In as many as 20% of cases, renal anomalies are associated with lower urinary tract malformations. The management of these complicated urinary tract anomalies often requires ablative as well as reconstructive surgery, which traditionally necessitates simultaneous abdominal and pelvic exposure through debilitating wide and/or separate incisions if repair at the same setting is to occur. The authors present two cases of transperitoneal laparoscopic nephroureterectomy (LN) using minimally invasive techniques in the management of complicated urinary tract anomalies. Two children aged 18 months and 12 years, respectively, with urinary tract anomalies (detrusor hypertrophy secondary to posterior urethral valves, and ureterocele, respectively) underwent LN with lower urinary tract reconstructive surgery. The LN was performed through three 5-mm trocar sites, and most tissue and vascular dissection was done with a 5-mm harmonic scalpel. Specimen retrieval and ureterocystoplasty or ureterocelectomy were accomplished through a small suprapubic incision. Patients were studied for safety of surgery, postoperative recovery, resolution of symptoms, and cosmetic results. The LN was performed successfully and safely in each case. Operative times were 89 and 92 min for the LN portion. Recovery was uniformly uneventful, and parenteral analgesics were unnecessary. Both patients were discharged on postoperative day 2 without delayed complications on follow-up visits. Cosmetic results were considered excellent in both cases. The authors advocate LN in the management of complicated urinary tract anomalies requiring nephroureterectomy. Potentially debilitating wide and/or separate incisions required to address these geographically separated anomalies at the same setting via traditional open techniques can thus be avoided.