Retroperitoneal laparoscopic partial nephro-urereterectomy in infants and children: analysis of risk factors and age related complications

• Published in: Journal of pediatric urology 2007, Vol.3, p.S80-S80
• Main Author: Haytham BADAWY, Elisabeth CARRICABURU, Yves AIGRAIN and Alaa EL GHONEIMI
• Format: Article
• Language: English
• Subjects: Pediatrics; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2007.01.145

PURPOSE Laparoscopic partial nephrectomy is a technically demanding procedure. Recently, there is increasing concern on the risks and outcome especially in young children. We analysed in detail our series and in particular young children to evaluate their specific risks and the operative steps to define the optimal technique to avoid complications. MATERIAL AND METHODS Between 1997 and 2006, 29 partial nephro-ureterectomies were performed, 21 upper poles (UPN) at mean age of 36 months (3-156) and 8 lower poles (LPN) at 39 months (1-121). The lateral retroperitoneal approach was used in all cases. Routine follow-up with renal ultrasound and Doppler of the remaining moiety were performed. For the past five years the technique was standardized to reduce complications: the kidney is kept attached to peritoneum, the pathological ureter is kept dilated by ligature at the beginning of surgery, and retrograde insertion of a ureteral catheter to allow methylene blue injection in cases of LPN or atypical UPN. RESULTS Our first patient, aged 7 yr, had an early postoperative renal artery thrombosis after UPN and required a total nephrectomy. Among the 10 UPN done in children under 1 yr, none had complications. One needed conversion in our first year of experience to identify the line of parenchymal section. 3 children underwent LPN under one yr, none had complications and no conversion even for a 60 mm dilated pelvis in a one month old child. Mean operative time was 150min (120-180) for LPN, and 150min (75-180) for UPN. All children had a well vascularized remaining moiety after a mean follow up of 36 months (6-60). CONCLUSIONS Partial nephro-ureterectomy remains a challenging laparoscopic procedure. The main limiting factor is the learning curve and not the age at surgery. We have learned from our early complications that few tips are necessary to make the retroperitoneal approach easier and safer. The procedure is now standardized and safely feasible even in young infants.