title: The BULT Method for Pediatric Minilaparoscopic Pyeloplasty in Infants: Technique and Results.
abstract: We reviewed retrospectively the results of transperitoneal minilaparoscopic pyeloplasty in children younger than 2 years. The surgical technique utilized as well as the retrograde placement of the stent is described in detail. Twenty-four consecutive children with a mean age of 7.9 months (range 1-23), a mean weight of 7.4 kg (range 4-12), and a mean follow-up of 18 months (range 3-59) are included. Preoperative grade of dilatation was 3.8 (SFU scale) and postoperatively improved to 1.5. The AP diameter of the pelvis decreased from a mean of 28-9 mm. In 83% of cases, there was complete resolution of hydronephrosis (grades 0-2) and the rest showed improvement. There was one conversion to open surgery in a child with a horseshoe kidney. There was one omental prolapse though a port site in a child in whom an inappropriate drain was used. There were no stent-related complications and no reinterventions for persistent or recurrent obstruction. Given these outcomes, low complication rate and excellent cosmetic results, we recommend transperitoneal minilaparoscopy with a double J stent and a perirenal drain for infants requiring pyeloplasty.
authors.affiliation: Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover, Niedersachsen , Germany.
authors.forename: Barbara Magda
authors.initials: BM
authors.lastname: Ludwikowski
authors.affiliation: Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover, Niedersachsen , Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Botländer
authors.affiliation: Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover, Niedersachsen , Germany.
authors.forename: Ricardo
authors.initials: R
authors.lastname: González
keywords: hydronephrosis; infants; laparoscopy; pediatric; pyelopalsty; ureteropelvic obstruction