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Outcome study of upper pole heminephroureterectomy in children
George Sakellaris1, Sisil Kumara, Raimondo M Cervellione
1Department of Paediatric Urology, Central Manchester and Manchester Children's University Hospital NHS Trust, Manchester, M27 4HA, UK. gsakell@mycosmos.gr
Insights
Upper pole heminephroureterectomy is effective for non-functioning moieties in duplex kidneys, with 81% of pediatric patients experiencing no long-term complications. This procedure offers a favorable outcome for obstructed upper segments contributing minimal renal function.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Anomalies
Background:
- Duplex kidneys are a common congenital anomaly.
- Non-functioning upper moieties can lead to complications such as urinary tract infections.
- Surgical intervention is often necessary for obstructed or poorly functioning renal segments.
Purpose of the Study:
- To evaluate the role and long-term outcomes of upper pole heminephroureterectomy in children with duplex kidneys.
- To assess the efficacy of this surgical approach for non-functioning upper renal moieties.
- To determine the complication rates associated with the procedure.
Main Methods:
- A retrospective review of 43 pediatric patients who underwent upper pole heminephroureterectomy over 10 years.
- Utilized various imaging modalities including ultrasound, DMSA, MCUG, MAG-3, IVU, and cystoscopy.
- Surgical approaches included combined flank and inguinal incisions or high flank incisions.
Main Results:
- The majority of patients (81%) had no long-term complications following surgery.
- Immediate post-operative complications occurred in 12% of patients, and late complications in 30%.
- A small percentage required a second procedure (9%) or experienced long-term incontinence (7%).
Conclusions:
- Upper pole heminephroureterectomy is a suitable treatment for obstructed upper segments in duplex kidneys when contributing less than 10% of renal function.
- The procedure demonstrates a favorable long-term safety profile in pediatric patients.
- Careful patient selection and surgical technique are crucial for optimal outcomes.
Objective:
We assessed the role and long-term outcome of upper pole heminephroureterectomy in the treatments of non-functioning upper renal moieties in children with duplex kidneys.
Methods:
In a period of 10 years, forty-three patients (male: female ratio 6:37) underwent upper pole heminephroureterectomy; a total of 25 patients were diagnosed prenatally. Imaging modalities included renal and bladder ultrasound in all 43 patients, static 99 m technetium dimercaptosuccinic acid (DMSA) in 21 patients, micturating cystourethrogram in 28 patients, MAG-3 in 13, cystoscopy in 30, IVU in 31 and DTPA, retrograde pyelography, antegrade pyelography in 1 patient. The main presentation was with urinary tract infections. Operation was performed through a combination of anterolateral loin incision plus right or left inguinal incision in 34 patients and high flank incision in 9 patients, for various abnormalities. One patient underwent also initial puncture of a ureterocele.
Results:
Five patients (12%) had immediate post-operative complications. Thirteen patients (30%) had late post-operative complications. Long-term follow-up revealed no complication in 35 (81%) patients and one (2%) patient had one episode of UTI and intermittent abdominal pain. Three patients (7%) had long-term incontinence. Four patients (9%) had a second procedure performed.
Conclusion:
Based on our experience, it seems that upper pole heminephroureterectomy is the treatment of choice in cases of obstructed upper segments of duplicated kidneys, when the affected segment contributes to less than 10% of the overall renal function.
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