A simplified technique of upper pole heminephrectomy for duplex kidney

Area of Science:

• Pediatric Urology
• Surgical Techniques
• Renal Anatomy

Background:

• Duplex kidneys are a common congenital anomaly.
• Upper pole moieties in duplex kidneys often present with poor function or complications like ectopic ureters or ureteroceles.
• Surgical intervention is frequently required to manage these nonfunctioning segments.

Purpose of the Study:

• To describe a simplified and safe surgical technique for upper pole heminephrectomy in pediatric patients with duplex kidneys.
• To evaluate the efficacy and safety of this simplified technique in terms of surgical time, blood loss, and postoperative complications.
• To highlight the advantages of this technique in preserving lower pole renal function and minimizing risks to adjacent structures.

Main Methods:

• A simplified technique involving direct excision of the upper pole after entering its collecting system.
• Identification and division of the upper pole vascular supply.
• Dissection of the upper pole ureter below the lower pole vessels.
• Application of the technique in 14 pediatric patients (11 girls, 3 boys) with nonfunctioning upper moieties of duplex kidneys.

Main Results:

• Mean surgical duration was 95 minutes.
• Clinically insignificant blood loss and a mean hospitalization of 2.7 days were observed.
• No significant postoperative complications occurred, with only transient atelectasis noted.
• Crucially, there was no injury to the lower pole ureter or its vascular pedicle.

Conclusions:

• The described technique offers a reliable and safe method for excising the upper pole in duplex kidneys.
• It maximizes the preservation of functioning lower pole parenchyma by clearly identifying moiety demarcation.
• The technique minimizes the risk of inadvertent injury to the lower pole collecting system, ureter, and vascular supply, leading to shorter hospital stays.