V09-02 ROBOTIC ASSISTED LAPAROSCOPIC PYELOLITHOTOMY IN A PEDIATRIC PATIENT WITH HORSESHOE KIDNEY

Abstract

INTRODUCTION AND OBJECTIVE: The incidence of nephrolithiasis in children has increased by 6-10% annually over the last two decades. Percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and ureteroscopy are accepted treatment modalities in children with normal anatomy and <2cm stone burden. The management of large volume nephrolithiasis in pediatric patients with complex anatomy such as horseshoe kidney has not been well described. This study aims to demonstrate that robotic assisted laparoscopic pyelolithotomy is a feasible treatment option for a pediatric patient with a staghorn calculus in a horseshoe kidney moiety. METHODS: The patient is a 7-year-old female with trisomy 13. She has a horseshoe kidney with nonfunctioning right moiety secondary to ureteropelvic junction obstruction status post multiple pyeloplasties and a ureterocalicostomy. She also has reflux nephropathy of the right moiety status post ureteral reimplant as an infant. Her baseline creatinine is 0.4. The patient was found to have a staghorn calculus in the left moiety during evaluation for recurrent urosepsis. She underwent a robotic assisted laparoscopic pyelolithotomy via a transperitoneal approach. RESULTS: The calculus was removed in its entirety via robotic assisted laparoscopic pyelolithotomy. The Foley catheter was removed on postoperative day 2, and the Jackson Pratt drain was removed on postoperative day 3 after which she was discharged home. Chemical analysis of the specimen revealed a struvite stone. The ureteral stent was removed 1 month postoperatively. The patient has been doing well on six-month follow up with no additional episodes of urosepsis. CONCLUSIONS: Robotic assisted laparoscopic pyelolithotomy can be safely performed to treat staghorn calculi in pediatric patients with complex anatomy including horseshoe kidneys. Source of Funding: None