title: Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience.
abstract: OBJECTIVE
  To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole.
  
  
  METHODS
  Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety.
  
  
  RESULTS
  Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety.
  
  
  CONCLUSIONS
  Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
authors.affiliation: Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany.
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Gözen
authors.affiliation: Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt.
authors.forename: Haytham
authors.initials: H
authors.lastname: Badawy
authors.affiliation: Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany.
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.affiliation: Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt.
authors.forename: Akram
authors.initials: A
authors.lastname: Assem
authors.affiliation: Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
keywords: DMSA, dimercaptosuccinic acid; Duplication; HN, heminephrectomy; HNU, heminephroureterectomy; Heminephrectomy; Laparoscopy; Retroperitoneoscopic; Transperitoneal; US, ultrasonography