Outcome of laparoscopic upper-pole nephrectomy in children with duplex systems

To report the results of laparoscopic upper-pole nephrectomy for children with duplex systems.

Nineteen laparoscopic transperitoneal upper-pole nephrectomies (11 on the left and 8 on the right) were performed in 17 patients with complete pyelocaliceal duplication. Postoperative follow-up consisted of clinical evaluation, as well as functional and image studies of the remaining lower unit with renal ultrasonography, 99mTc-DMSA, voiding cystourethrography, and urography or enhanced helical CT, according to individual needs.

The mean operative time was 147 minutes (range 110-180 minutes). There were no conversions to open surgery and no transfusions. The mean follow-up was 57.1 months. Lower-unit function was preserved after 18 procedures (94.7%). Transient asymptomatic urinary-tract infection was observed in 5 of 17 children (29.4%). Vesicoureteral reflux resolved in 3 of 4 children (75%) and improved in the other, and all 7 ureteroceles associated with the resected upper unit were decompressed, although two (28.6%) remained present asymptomatically by ultrasonography. Empyema of the lower-ureteral stump was a late complication in 3 of the 19 duplex systems.

Laparoscopic transperitoneal polar nephrectomy in children with pyelocaliceal duplication is feasible and presents all the advantages of minimally invasive procedures. It has good long-term results, as judged by preservation of the lower unit, regression of ureterocele and reflux, and reduction in the incidence of infection.