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Laparoscopic repair of congenital midureteric strictures in infants and children
1Pediatric Surgery, Pediatric Urology & MAS, Rainbow Children's Hospitals, Hyderabad, India.
Insights
Laparoscopic repair of congenital midureteric strictures (CMUS) is safe and effective in children. This minimally invasive approach offers excellent outcomes for obstructive uropathy, even in infants.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Congenital Abnormalities
Background:
- Congenital midureteric strictures (CMUS) are a rare cause of obstructive uropathy in children.
- Laparoscopic management of CMUS is infrequently reported.
- This study details the experience with laparoscopic repair in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic repair for congenital midureteric strictures in children.
- To present surgical outcomes and follow-up data for pediatric patients undergoing this procedure.
Main Methods:
- Retrospective review of 7 children (5 infants) with CMUS undergoing laparoscopic reconstruction.
- Preoperative imaging included ultrasound, diuretic renography, and in some cases, IVU/MRU and retrograde pyelography.
- All patients underwent transperitoneal laparoscopic stricture excision with ureteroureterostomy.
Main Results:
- Laparoscopic repair was successfully completed in all 7 children with no major intraoperative or postoperative complications.
- At a median follow-up of 18 months, all patients were asymptomatic.
- Imaging confirmed significant reduction in hydronephrosis and improved urinary drainage, with excellent cosmetic results.
Conclusions:
- Laparoscopic repair of CMUS is a safe and effective treatment option in pediatric patients, including infants.
- This minimally invasive technique provides favorable functional and cosmetic outcomes for congenital midureteric strictures.
Purpose:
Congenital midureteric strictures (CMUS) are an uncommon cause of obstructive uropathy. There are only a few case reports of laparoscopic management of CMUS. We present our experience with laparoscopic repair of CMUS in 7 children.
Patients And Methods:
The records of all children (n=7, 5 infants) undergoing laparoscopic reconstruction for CMUS were reviewed. Preoperative imaging included ultrasound (US) and diuretic renography (DR) in all children. Intravenous urography or magnetic resonance urography was performed in 3 children when a dilated ureter was seen on the ultrasound. Retrograde pyelography was performed in 6 children before definitive surgery. All children underwent transperitoneal laparoscopic excision of the stricture with ureteroureterostomy. Follow-up included clinical examination and US in all children, with DR in 5 children.
Results:
Over a 3-year period, 7 children underwent laparoscopic repair of CMUS. Six children had antenatally diagnosed hydronephrosis, while one child presented with infected hydronephrosis, underwent nephrostomy and was later referred to us. The diagnosis of CMUS was suspected preoperatively in 4 children; in 3 children, diagnosis of CMUS was confirmed on retrograde pyelography. Laparoscopic repair was successfully completed in all children; there were no significant intraoperative or postoperative complications. At a median follow-up of 18months, all children are asymptomatic, with US (7) and DR (5) confirming significant reduction in the hydronephrosis and improved drainage. The cosmetic results have been excellent.
Conclusion:
To our knowledge, this is the first report of laparoscopic repair of CMUS in children. Laparoscopic repair of CMUS can be safely and successfully performed even in small infants, with good results.
