Upper-pole Heminephrectomy Research Articles

Minimizing and managing needle and instrument loss during pediatric robotic surgery

IntroductionLost objects and equipment malfunctions during robotic and laparoscopic cases can lead to an increase in operating time and potential risk to the patient. The literature on the management of foreign bodies during pediatric robotic-assisted surgery is limited. The purpose of the video is to review proper instrument handling to prevent loss of an object and to propose our technique for retrieving lost objects through two pediatric case examples. Materials and MethodsThe first case is a robotic-assisted laparoscopic left pyeloplasty in a 6-week-old male with congenital uteropelvic junction obstruction during which a needle was lost. In the video, we describe our techniques for safe needle passage, proper suturing technique, and recovering a lost needle.The second case is a robotic-assisted right upper pole heminephrectomy in a 14-month-old female with a duplicated renal collecting system and hydroureteronephrosis. We present the management of a rare case during which a harmonic scalpel jaw malfunctioned leading to a lost foreign body. We describe our technique for retrieving the lost fragment. ResultsAll objects were safely removed, and patients were discharged post-op day one without complication. ConclusionOur video presents two case examples of foreign bodies lost during pediatric robotic surgeries and approaches to manage each of these incidents.

Bilateral complete duplication of ureter with ectopic ureter presenting as persistent urinary dribbling with normal voiding pattern in 17-year-old female: Case report

and importance: Bilateral complete ureteral duplication is a rare urinary tract abnormality and presence of unilateral ectopic ureter makes it a rarest entity. Continuous urinary dribbling with normal voiding pattern and recurrent UTI are frequent presenting complains in case of ectopic ureter. Long term childhood problem of urinary incontinence with delayed diagnosis in adult in this case makes it a perfect case to report. We present a case of 17-year-old girl with continuous urinary dribbling and constant wetting with normal voiding pattern since childhood. She also had recurrent history of urinary tract infections. Local external examination of genitourinary system was found to be normal. There were skin lesions on buttocks and thighs suggestive of urine dermatitis. There were no examination findings of other congenital anomalies. Complete blood count, Renal function test, Serology, Urine R/ME, Urine culture and sensitivity, Ultrasound abdomen and pelvis, Computed Tomography scan, intraoperative cystoscopy were done. Right upper pole hemi nephroureterectomy was performed. She was post operatively managed with IV Fluids, antibiotics, analgesics, antipyretics and antiemetics. She is asymptomatic now and regularly followed up on OPD basis. Congenital abnormalities of the genitourinary system like ectopic ureter should be clinically suspected in case of persistent urinary problems like urinary dribbling with normal voiding pattern and recurrent urinary tract infections. Upper pole heminephrectomy is an ideal choice of treatment in case of nonfunctional upper moiety. This case emphasizes the early detection of genitourinary abnormalities and provide the perspective on late diagnosis and management in such cases.

Is lower urinary tract surgery without upper pole heminephrectomy safe and effective in the long-term treatment of duplex system ureterocele?

Objective: The study aimed to retrospectively evaluate postoperative results of patients with duplex system ureterocele (DSU) who underwent endoscopic ureterocele incision (UI), lower urinary tract reconstruction (LUTR) or both, and investigate the necessity of upper pole heminephrectomy (UPH) in ureterocele treatment. Patients and methods: In total, 44 patients with DSU who were operated on in December 2005 and December 2018 were evaluated for patient characteristics, ureterocele location, differential renal function (DRF), vesicoureteral reflux (VUR), postoperative incontinence, proteinuria, hypertension and urinary tract infection (UTI). Results: UI was performed in 27 of 44 cases (61.3%) as the first-line treatment. Ten of them (37%) had no urinary infection or renal function loss at a mean of 3 years (1.5–7 years). LUTR was needed in 17 patients after UI due to VUR in 14 patients and bladder outlet obstruction (BOO) in 3 patients. In total, 34 patients who underwent LUTR, proteinuria or incontinence were not detected in the mean 6 years’ follow-up. Thirty-three patients (97%) had identical renal scans and similar DRF before and after the operation. No patient underwent UPH. Conclusion: UI must be considered the first-line treatment in DSU in infancy. In older patients, especially with VUR, LUTR is effective and safe and UPH mostly is not necessary. Level of evidence: 4

MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES?

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES? Aznive Aghababian, Sameer Mittal, Sahar Eftekharzadeh, John Weaver, Katherine Fischer, Christopher Long, Dana Weiss, Jason Van Batavia, Mark Zaontz, Thomas Kolon, Stephen Zderic, Douglas Canning, Aseem Shukla, and Arun Srinivasan Aznive AghababianAznive Aghababian More articles by this author , Sameer MittalSameer Mittal More articles by this author , Sahar EftekharzadehSahar Eftekharzadeh More articles by this author , John WeaverJohn Weaver More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Christopher LongChristopher Long More articles by this author , Dana WeissDana Weiss More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Mark ZaontzMark Zaontz More articles by this author , Thomas KolonThomas Kolon More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Douglas CanningDouglas Canning More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal management for ureteroceles has long been under debate, due to the anatomic variability and severity of this entity. Treatment strategies range from upper pole heminephrectomy or major bladder reconstruction, to isolated endoscopic incision. We hypothesize that a carefully selected group of ureteroceles can be successfully managed without surgical intervention. METHODS: We retrospectively reviewed medical records of all patients with a diagnosis of ureterocele who were managed at our institution from 2010-2019. Patients were categorized into two groups: non-surgical management and surgical management. Non-surgical management included those who had at least 6-month follow-up with no interventions including ureterocele puncture. We analyzed baseline demographics, clinical presentation, imaging details, history of urinary tract infection (UTI), and if any procedures were performed during the follow-up period. RESULTS: We identified 240 ureteroceles in 231 patients: 56 (23%) were managed without immediate puncture and 184 (77%) surgically. Patients who underwent non-puncture management were more likely to have an intravesical ureterocele, ipsilateral multi-cystic dysplastic kidney, and were unlikely to have hydronephrosis and/or reflux on the ipsilateral side. Of 56 patients in the non-incision cohort, 6 (10%) required surgery after a median observation of 2.5 years (IQR 2.1-4.5), with 4 ureteroceles associated with a duplex system (3 intravesical and 1 ectopic) and the other 2 associated with absent kidney and an ectopic insertion. The remaining 50 (90%) did not require any surgical intervention during a median follow-up of 2.4 years (IQR 0.9-4.6). In the cohort of 50 patients who did not undergo intervention, 35 (70%) were on antibiotic prophylaxis, and febrile UTIs occurred in 12 (24%) patients from this group. Multivariate regression analysis showed that intravesical ureteroceles were more likely to be successfully managed non-operatively than ectopic ureteroceles (OR: 103.6, 95% CI: 1.4–733.5). CONCLUSIONS: Children with ureteroceles without evidence of obstruction, and/or functional renal tissue can be successfully managed without puncturing the ureterocele. An intravesical ureterocele in these children may be a predictor of success. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e899-e899 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aznive Aghababian More articles by this author Sameer Mittal More articles by this author Sahar Eftekharzadeh More articles by this author John Weaver More articles by this author Katherine Fischer More articles by this author Christopher Long More articles by this author Dana Weiss More articles by this author Jason Van Batavia More articles by this author Mark Zaontz More articles by this author Thomas Kolon More articles by this author Stephen Zderic More articles by this author Douglas Canning More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement PDF downloadLoading ...

Laparoscopic Upper-pole Heminephrectomy for the Management of Duplex Kidney: Outcomes of a Multicenter Cohort

ObjectiveTo analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. Materials and MethodsA retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a nonfunctional moiety between August 2007 and December 2019 was conducted at 3 centers. A total of 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: (1) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of vesicoureteral reflux (VUR), and differential renal function (DRF) on renal scintigraphy; and (2) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, febrile urinary tract infection, lower urinary tract symptoms, and need for further surgery. Findings were considered statistically significant at P <.05. ResultsPostoperative complications were observed in 5 patients (3.8%). Six patients (4.6%) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries odds ratio (OR) 4.91, P = .0415) and the occurrence of postoperative febrile urinary tract infection (OR 2.81, P = .0376). A 13.9% incidence of lower urinary tract symptoms was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. ConclusionLaparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found.

Duplicated Collecting System and Ectopic Ureter with Vaginal Implantation Treated by Laparoscopic Upper Pole Heminephrectomy and Ureterectomy: A Case Series of Six Patients

Abstract Objective: To present the results of a case series of six patients with a duplicated collecting system with ectopic vaginal implantation who underwent laparoscopic heminephrectomy and uret...

Dorsal lumbotomy for pediatric upper pole hemi-nephrectomy: Back (door) to the future?

Upper pole heminephrectomy (UHN) is performed for two main indications in children: ectopic ureterocele and duplication anomalies with upper pole ectopy, both in the context of a poorly functioning upper pole moiety. Current popular techniques for conducting UHN include laparoscopic (LPN) and robot-assisted laparoscopic (RAPN). To evaluate outcomes following dorsal lumbotomy (DL), an open approach used historically for pyeloplasty and pyelolithotomy, and in which no clinical trials or exclusive case-series have been conducted for upper pole hemi-nephrectomy (UHN) in children. We ultimately aim to compare our outcomes following DL at our centre to that of published outcomes of minimally invasive approaches to UHN. Institutional board review was obtained (H18-03716) for a retrospective review of 50 UHN performed in 49 consecutive pediatric patients using the DL approach by a single surgeon between 2001 and 2019. Clinical variables and indicators included age, sex, weight, skin-to-skin time, total operating room time, duration of hospital stay, post-operative complications, analgesic requirements, and post-operative ultrasound results. Of 50 UHN performed, 23 had a presurgical diagnosis of ectopic ureter, and 27 ureterocele. Mean weight of patients was 12.61kg, and the mean age at surgery was 24.55 months. Mean (range) for time between skin incision and closure was 88.5 (62-132) minutes, and the mean (range) total operating room time was 138.5 (70-180) minutes. There were neither intraoperative complications nor transfusions. The mean (range) post-operative opioid delivered was 0.73 (0.00-2.00) mg/kg/day. Mean (range) post-operative ibuprofen delivered was 5.41 (0.00-37.73) mg/kg/day. Median length of hospital stay was 2 days. No patient received post-operative prescriptions for narcotics at discharge. There were no wound complications. One patient had secondary atrophy of the lower pole. Secondary lower tract surgery, unrelated to surgical approach, was performed in five patients. Ten patients experienced a urinary tract infection at some point after surgery. DL is safe, feasible, and produces operative outcomes and times comparable to that of laparoscopic and robotic techniques. These findings as well as operative costs should be considered when selecting a surgical technique for UHN.

Percutaneous Transgluteal Ureteral Stump Access: A Novel Approach to Hybrid Management of Ureteral Stump Syndrome

Duplicated collecting systems with minimal-to-no function of the upper moiety are often treated surgically with upper pole heminephrectomy and ureterectomy. Complications associated with the ureteral stump can occur and are collectively known as ureteral stump syndrome. We present a case of ureteral stump syndrome treated with percutaneous transgluteal access into the stump which aided in identification of an ectopic ureteral opening that could not be identified by surgical means alone.

Renal Outcome of Children With Horseshoe Kidney: A Single-center Experience

To assess the clinical features, additional abnormalities, and renal consequences of children with horseshoe kidney (HSK). The medical records of 41 children with HSK followed in our pediatric nephrology clinic between the years of 2004 and 2014 were retrospectively reviewed. There were 22 girls (53.6%) and 19 boys (46.4%) aged 60 (2-192) months. The median follow-up time was 48 (12-120) months. HSK was incidentally found in 12 patients (29.3%), and 5 patients (12.2%) were prenatally diagnosed. Urinary tract abnormalities including vesicoureteral reflux (n= 8), ureteropelvic junction obstruction (n= 7), and duplex system (n= 3) were identified in 18 patients (43.9%). Eight children (19.5%) had bladder dysfunction, and 9 patients (21.9%) had additional systemic abnormalities. Urinary tract infection had been detected in 17 patients (41.4%). Seven patients (17%) required surgical intervention including pyeloplasty (n= 3), ureteroneocystostomy (n= 3), and upper pole heminephrectomy (n= 1). Renal scarring (RS) occurred in 10 patients (24.4%). Six patients (14.6%) developed proteinuria and 4 (9.8%) complicated with hypertension. Three patients (7.3%) progressed to chronic kidney disease (CKD). Multivariate logistic regression analysis showed that proteinuria, hypertension, and RS are independently associated with CKD. Children with HSK might be examined for additional urologic and nonurologic abnormalities. Patients might be closely followed up for the increased risk of urinary tract infection and RS. Proteinuria, hypertension, and presence of RS seem to be the major determinants for progression to CKD in children with HSK.

VE06: Laparoscopic robot-assisted upper pole heminephrectomy for functionless part of duplex kidney. Case report

VE06: Laparoscopic robot-assisted upper pole heminephrectomy for functionless part of duplex kidney. Case report

Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney

To discuss management of chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney. Between November 2004 and Februar y 2011, 39 patients underwent retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, of these 5 patients had chylous leakage. The ages of the patients ranged from 32 to 60 years (mean 42). All the patients were treated conservatively, and the therapeutic effects were observed. Delayed chylous leakage in 5 patients occurred 5-31 days after surgery, and leakage occurred in 4 of the same 5 patients during the first 2 post-operative years. Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney preferentially occurred at the left side of duplex kidney. All the patients healed under conservative treatment. Chylous leakage typically occurs after left retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, and can be prevented by improving surgical technique; it can be completely relieved by conservative management with satisfactory results.

88 Robot assisted laparoscopic upper pole heminephrectomy and ureterectomy in a patient with an ectopic ureter

88 Robot assisted laparoscopic upper pole heminephrectomy and ureterectomy in a patient with an ectopic ureter

Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: A multicenter review

Purpose To evaluate outcomes following laparoscopic heminephrectomy (LHN) in duplex kidneys in the pediatric population, focusing on the fate of the remnant moiety. Methods 142 patients underwent laparoscopic heminephrectomy for duplex kidney across 4 different institutions in the U.S. and Europe. Median age at surgery was 11.4 months. A retroperitoneoscopic approach was used in all patients, with 82 (57.7%) patients placed in posterior prone position (PPR), and 60 (42.3%) in lateral retroperitoneal (LRP). Follow up included routine ultrasound, and DMSA was performed in the event of abnormalities in ultrasound or postoperative course. Results Median operative time was 120 min. 11 patients (7.7%) required open conversion, the majority of which (8/11) occurred prior to 2000. Median hospital stay was 2 days and no major complications were observed. 7 patients (4.9%) developed a postoperative urinoma, and 1 patient required ureterectomy for urinary tract infection. With a median follow-up of 4.5 years, 7 children (4.9%) experienced significant loss of function in the remaining moiety, with 3 patients requiring completion nephrectomy. Of patients losing their remaining moiety, median age at surgery was 9 months [4 – 42], and all except 1 (6/7) had an upper pole heminephrectomy. Three patients in this group (42%) experienced an immediate postoperative complication (hematoma, UTI, urinoma). No consistent preoperative or technical factors were consistent in the renal loss group. Conclusions LHN for duplex kidney produces satisfactory outcomes in the pediatric population. With a median follow up of 4.5 years, we demonstrate a non-functioning renal moiety rate of 5%. We did not identify any clinical predictors of this outcome in our series, although upper pole heminephrectomy, patient age, and postoperative complications may be contributing factors.

Transperitoneal Laparoscopic Upper Pole Heminephrectomy in Pediatric Patients with Duplex Kidneys: Comparison with an Age-Matched Cohort of Open Surgery

Purpose: We evaluated the safety and feasibility of transperitoneal laparoscopic upper pole heminephrectomy (TLUHN) in pediatric patients by comparing an age-matched cohort undergoing open upper pole heminephrectomy (OUHN) by a single surgeon. Materials and Methods: A total of 10 OUHNs were performed between 1995 and 2003 and 10 TLUHNs between 2003 and 2008. The 10 patients in each group were matched by age (p=0.94), gender (p=1.0), and body weight (p=0.91). Results: There was no open conversion in the TLUHN group. The median operative time in the TLUHN and OUHN groups was 174 minutes (range, 98-205) and 190 minutes (range, 120-258), respectively (p=0.19). In the TLUHN and OUHN groups, the median blood loss was 25 ml (range, 20-30) and 35 ml (range, 20-100) (p=0.74), the median analgesic requirement was 0 hours (range, 0-42) and 0 hours (range, 0-87) (p=0.16), and the median hospital stay was 5.5 days (range, 3-7) and 7 days (range, 3-19) (p=0.01), respectively. There were no intraoperative complications in either group. Postoperative atelectasis occurred in two and five patients in the TLUHN and OUHN groups, respectively. Similar results were found in the subanalysis of patients younger than 24 months. Conclusions: TLUHN is safe and feasible even in small children and infants. Furthermore, decreased hospital stay is the main advantage of the laparoscopic approach compared with open surgery. (Korean J Urol

The Harmonic Scalpel in the Infant Upper Pole Heminephrectomy

PURPOSE Upper-pole heminephrectomy is commonly performed in pediatric urology for non-functioning moieties often associeated with ureteroceles. We have modified our open approach to incorporate the Harmonic Scalpel (Johnson and Johnson) and have found that this facilitates and simplifies the procedure. MATERIAL AND METHODS Three patients ranging in age from 3-6 months underwnt a modified flank heminephrectomy for non-functioning duplicated upper pole segment. Pre-operative evaluation included renal bladder ultrasound, voiding cystourethrogram, and nuclear renal scan. The upper-pole moiety was exposed in conjunction with its ureter. Its blood supply was defined using demarcation after applying a bulldog clamp to the small sub-tending vessels. The Harmonic Scalpel (Johnson and Johnson) was then used to separate the upper pole as demonstrated in the video. Following this the ureter was divided near the bladder. RESULTS Operative time was less than 90 minutes in all three procedures. Blood loss was negligable (< 10 cc). All patients were discharged by post-operative day 2. A followup renal ultrasound at three months demonstrated a normal appearing lower pole moiety in all patients. CONCLUSIONS The harmonic scalpel simplifies the open upper pole heminephrectomy. It is a compact precision tool which simultaneously cuts and coagulates. Because it limits lateral thermal damage, it decrease the possibility of injury to the lower pole vascular pedicle. We found it simple to use and recommend its use for these procedures.

Percutaneous Endoscopic Management of Persistent Urine Leak after Partial Nephrectomy

As nephron-sparing surgery becomes more commonly used for the management of renal masses, the incidence of complications unique to this procedure will increase. Urine leak after partial nephrectomy (PN) is a common occurrence that can be difficult to manage if conservative measures fail. We describe our approach for persistent urine leaks after PN. Two patients presented with urine leaks after PN. After an upper-pole heminephrectomy, fever developed in the first patient. CT showed an intra-abdominal fluid collection, and percutaneous drainage confirmed a urine leak with persistently high outputs from an upper-pole calix. Conservative management, including ureteral stent, Foley catheter, and percutaneous nephrostomy (PCN) drainage failed. The calix was then directly accessed percutaneously, dilated to 30F, and a 22F nephrostomy tube was placed through the tract into the renal pelvis. The urine leak quickly resolved. The second patient had a lower pole heminephrectomy, and a urine leak with nephrocutaneous fistula from the posterior aspect of the upper-pole remnant developed. Again, conservative measures failed before percutaneous endoscopy. The PCN tract was dilated to 30F, and 3 weeks later the leaking calix was fulgurated through the tract with a flexible ureteroscope. Both patients had complete resolution of urine leaks, stable creatinine levels, and required no further intervention. Urine leak after PN remains a complex problem if conservative measures are unsuccessful. We describe a novel technique to percutaneously manage persistent urine leak after PN through a minimally invasive approach.

Pelvi‐ureteric junction obstruction in duplex kidneys

To report our experience of 11 children with pelvi-ureteric junction obstruction (PUJO) in a duplex kidney and to review previous reports. From 1995 to 2005 the second author (G.H.H.S.) performed 145 pyeloplasties in single-system kidneys and in 11 children with PUJO in a duplex kidney. Upper and lower pole obstructions were found in both complete and incomplete duplicated systems. Investigations included renal ultrasonography, renal scintigraphy, micturating cystography, cystoscopy and retrograde pyelography. Ten patients had surgery (eight dismembered pyeloplasties, one upper-pole heminephrectomy, one pyelo-ureterostomy). Three children had obstruction of the upper moiety and eight had obstruction of the lower moiety. Upper and lower pole obstructions were found in both complete and incomplete duplicated systems. Upper-pole obstruction in a duplex kidney is rare; the present series suggests that it is more common than previously reported.

Laparoscopic Upper Pole Partial Nephrectomy for Duplicated Renal Collecting Systems in Adult Patients

Ureteral duplication is a relatively common congenital anomaly of the genitourinary tract. When symptomatic due to urinary tract infection or flank pain, the standard surgical treatment is upper pole heminephrectomy. Until relatively recently surgery involved a flank incision with significant morbidity and prolonged recovery time, especially for adult patients. We report our experience with laparoscopic upper pole partial nephrectomy (LUPPN) in adult patients with a duplicated collecting system and an obstructed, poorly functioning upper pole renal moiety. After reflecting the colon medially, both ipsilateral duplicated ureters are identified, with distinction between the two aided by the presence a previously positioned ureteral catheter in the lower pole ureter. The upper pole ureter is then dissected cephalad toward the renal hilum and upper pole atrophic moiety. The vascular supply to the upper pole renal moiety is meticulously dissected and controlled using vascular clips. The renal upper pole moiety is then excised along the atrophic cleavage plane using electrocautery or a harmonic scalpel. We retrospectively reviewed the medical records of 5 patients who underwent LUPPN at our institution between October 2000 and June 2005. All patients underwent the procedure without intraoperative complications. Laparoscopic upper pole partial nephrectomy for an obstructed upper pole moiety is a safe treatment modality with low morbidity and good outcomes.

One stage laparoscopic hemi-nephroureterectomy with excision of ureterocele and ureteric reimplantation: long term outcome

Purpose To evaluate the long term outcome after the one-stage laparoscopic hemi-nephroureterectomy with simultaneous excision of ureterocele, and reimplantation of the normal moiety ureter. Material and methods Nineteen patients (M/F: 3/16) underwent the procedure. Mean age at surgery was 1.81years (range 1m - 7.24 years). All patients had a duplex system with a non- functioning upper moiety and large complicating ectopic caecoureterocoeles which persisted despite previous cystoscopic incision. VUR occurred in 8 patients (3 bilateral). All patients underwent the one - stage laparoscopic procedure via a transperitonial route with endoscopic upper pole heminephrectomy with extravesical excision of the ureterocele, and reimplantation of the lower moiety ureter. All patients were regularly followed every 3 months and repeated radiological assessments including US, VCUG and DMSA were done at 12 months and then at yearly interval afterwards. Complete resolution of the VUR was confirmed based on negative findings on follow up VCUG. Results The procedure was successful in all patients and no procedure-related complications were observed. Mean follow up was 4.45 years (range.1.1 – 8 yrs). None of the patients in this series showed functional loss in the remaining ipsilateral moiety. Follow-up cystogram showed complete resolution of VUR in all 8 patients (100 %). Two patients developed UTI during the follow up period and none of them developed a new renal scar. Cosmetic results were excellent in all patients and no long-term complications have been encountered so far. Conclusions Our experience demonstrates that this radical definitive surgery can be safely and effectively performed in a single stage laparoscopic procedure. The procedure minimizes the hazards of traditional open surgical reconstruction. Furthermore, the long-term successful outcome in our series establishes this unique procedure as safe and effective in treating infants with renal duplication associated with ectopic ureteroceles.

Comparison of Laparoscopic and Open Partial Nephrectomy for Duplication Anomalies in Children

We compared the outcome of laparoscopic vs open PN for duplication anomalies at our institution. We retrospectively reviewed the records of all patients undergoing PN within the last 4 years. A total of 34 patients (16 females) were divided into 2 groups. Group 1 consisted of 20 patients undergoing open PN between 2000 and 2003, and group 2 consisted of 14 patients undergoing laparoscopic PN between 2003 and 2004. Mean patient age was 21 months in group 1 and 18 months in group 2. Diagnosis was ectopic ureter in 18 patients, ureterocele in 11, VUR in 4 and ureteropelvic junction obstruction in 1. Cystoscopy was performed as part of the procedure in 30% of the patients in group 1 and 100% of those in group 2. Simultaneous lower tract procedures were performed in 3 patients in group 1 and 2 patients in group 2. Mean duration of PN was 115 minutes for group 1 and 180 minutes for group 2. There was no significant bleeding or need for transfusion except in 1 patient in the open group. Median hospitalization was 3 days for group 1 and 2 days for group 2. Mean analgesic requirement was 2.3 doses of opioids and 2 doses of ketorolac for group 1, and 3.2 doses of opioids for group 2. Acetaminophen only was used in 3 of 20 patients in group 1 and 5 of 14 in group 2. There were 2 complications in each group, namely 1 case of ureteral bleeding and 1 lower pole ureteral injury in group 1, and 1 omental hernia and 1 urinoma in group 2. Laparoscopic PN is feasible even in small infants, and the results are comparable to the open procedure. Length of hospitalization was shorter in the laparoscopic group. In our series the learning curve for this technique was rapid, and after a few cases the procedure could be done in the same time as open surgery, with the advantages offered by laparoscopy.