title: Indications for nephrectomy in children: what has changed?
abstract: BACKGROUND
  The last decade has witnessed significant refinements in preoperative diagnostic evaluation and an improvement in surgical techniques and postoperative management for paediatric patients. There has been an improvement in our understanding of the natural history of some congenital renal anomalies which has caused some changes in management approach.
  
  
  OBJECTIVE
  To review the indications for nephrectomy in children between 1996 and 2008, at the departement of paediatric surgery, children's hospital in Tunis.
  
  
  METHODS
  There were 80 nephrectomies. A retrospective review of the patients' notes was performed. The 13-year period was divided into two halves (1996-2000 and 2001-2008) which were then compared.
  
  
  RESULTS
  The total number of nephrectomies per year significantly increased over the period of the study (4, 6 and 8 nephrectomies per year for 1996-2000 and 2001-2008, respectively; P < 0.05), as did the number of nephrectomies for Multicystic dysplastic kidney (MCDK) (zero and 5 for 1996-2000 and 2001-2008, respectively) and wilms'tumour (8.3% and 29,16% for 1996 - 2000 and 2001 - 2008, respectively). Wilms' tumour, vesico-ureteric reflux (VUR) and pelvi-ureteric junction (PUJ) obstruction accounted for more than half of the nephrectomies (80% and 58% for 1996-2000 and 2001-2008, respectively). The proportion of nephrectomies performed for VUR did not change (15% and 12% for 1996-2000 and 2001-2008, respectively) but fewer nephrectomies were performed for pelvi-ureteric junction (PUJ) obstruction in the second half of the study period (44% and 4,16% for 1996-2000 and 2001-2008, respectively ; P < 0.05).
  
  
  CONCLUSIONS
  The total number of nephrectomies, including partial nephrectomies, has increased significantly. The decrease in nephrectomies for PUJ obstruction could be accounted for by a more aggressive approach in the management and follow up of prenatally diagnosed hydronephrosis. Of note is that there was no significant change in the proportion of nephrectomies performed for VUR. On the contrary, the proportion of nephrectomies increased for neoplastic lesions and MCDK.
authors.affiliation: Department of Paediatric Surgery, children's Hospital, Tunis, Tunisia.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Nouira
authors.forename: Nadia
authors.initials: N
authors.lastname: Sarrai
authors.forename: Soufiane
authors.initials: S
authors.lastname: Ghorbel
authors.forename: Yacoub Ould Med
authors.initials: YO
authors.lastname: Sghair
authors.forename: Rachid
authors.initials: R
authors.lastname: Khemakhem
authors.forename: Awatef
authors.initials: A
authors.lastname: Chariag
authors.forename: Said
authors.initials: S
authors.lastname: Jlidi
authors.forename: Beji
authors.initials: B
authors.lastname: Chaouachi
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D014416:Tunisia / Q000453:epidemiology