Outcome and cost analysis of laparoscopic or open surgery versus conservative management for multicystic dysplastic kidney.
OBJECTIVE
To determine whether laparoscopic nephrectomy (LN), open nephrectomy (ON), or observation (OB) is most efficient for managing multicystic dysplastic kidney (MCDK).


METHODS
We performed a retrospective review of the management of our 12-year clinical experience of 32 MCDK patients to analyze the estimated total cost (ETC) of various treatment options and compare them with respect to survival, development of hypertension, and postoperative cosmetic appearance, to determine the most efficient treatment option.


RESULTS
There were 12 cases in the LN group, 6 in the ON group, and 14 in the OB group. ETC was lower for ON than for LN. But the length of preoperative observation and length of follow-up after spontaneous regression greatly affected ETC. If MCDK cases were observed > 5 years with standard investigations performed regularly, ETC was higher for the OB group than for the LN group. In 6/14 (42.9%) of OB cases, MCDK resolved within 5 years, and this subgroup had the lowest ETC up to the time of this review. Six cases initially in the OB group were managed surgically (4 by LN and 2 by ON) in accordance with parental requests, and ETC in these cases was highest. All cases are well after a mean follow-up of 5.7 years, without any impairment of renal function, or hypertension.


CONCLUSIONS
The decision to operate after lengthy observation increases costs. Overall, the most efficient surgical technique for managing MCDK was LN because of greater patient satisfaction with postoperative cosmesis. We recommend MCDK be treated by LN after a short period of observation.
Yamataka
Atsuyuki
A
Department of Pediatric Surgery , Juntendo University School of Medicine, Tokyo, Japan. yama@med.juntendo.ac.jp
Satake
Shoei
S
Kaneko
Kazunari
K
Ohtomo
Yoshiyuki
Y
Okada
Yasuhiro
Y
Lane
Geoffrey J
GJ
Yamashiro
Yuichiro
Y
Miyano
Takeshi
T
D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D021782:Multicystic Dysplastic Kidney / Q000191:economics / Q000401:mortality / Q000601:surgery*; D009392:Nephrectomy / Q000191:economics*; D017060:Patient Satisfaction; D011183:Postoperative Complications