Outcome of laparoscopic upper-pole nephrectomy in children with duplex systems.
OBJECTIVE
To report the results of laparoscopic upper-pole nephrectomy for children with duplex systems.


METHODS
Nineteen laparoscopic transperitoneal upper-pole nephrectomies (11 on the left and 8 on the right) were performed in 17 patients with complete pyelocaliceal duplication. Postoperative follow-up consisted of clinical evaluation, as well as functional and image studies of the remaining lower unit with renal ultrasonography, 99mTc-DMSA, voiding cystourethrography, and urography or enhanced helical CT, according to individual needs.


RESULTS
The mean operative time was 147 minutes (range 110-180 minutes). There were no conversions to open surgery and no transfusions. The mean follow-up was 57.1 months. Lower-unit function was preserved after 18 procedures (94.7%). Transient asymptomatic urinary-tract infection was observed in 5 of 17 children (29.4%). Vesicoureteral reflux resolved in 3 of 4 children (75%) and improved in the other, and all 7 ureteroceles associated with the resected upper unit were decompressed, although two (28.6%) remained present asymptomatically by ultrasonography. Empyema of the lower-ureteral stump was a late complication in 3 of the 19 duplex systems.


CONCLUSIONS
Laparoscopic transperitoneal polar nephrectomy in children with pyelocaliceal duplication is feasible and presents all the advantages of minimally invasive procedures. It has good long-term results, as judged by preservation of the lower unit, regression of ureterocele and reflux, and reduction in the incidence of infection.
Dénes
Francisco T
FT
Urologic Clinic, São Paulo University, São Paulo, Brazil.
Danilovic
Alexandre
A
Srougi
Miguel
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography