Laparoscopic Pyeloplasty in children with Horseshoe Kidney
Paulo Renato Marcelo Moscardi1, Roberto Iglesias Lopes1, Marcos Figueiredo Mello1
1Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
Insights
Laparoscopic pyeloplasty is a safe and effective treatment for children with ureteropelvic junction obstruction (UPJO) associated with horseshoe kidneys, demonstrating good outcomes and low complication rates.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Congenital Anomalies
Background:
- Horseshoe kidney affects 1 in 400-800 live births, with a 2:1 male predominance.
- Ureteropelvic junction obstruction (UPJO) frequently co-occurs with horseshoe kidneys due to factors like variable blood supply and ureteral abnormalities.
- The management of UPJO in horseshoe kidneys presents unique surgical challenges.
Observation:
- A case series of six pediatric patients (five males, one female) with UPJO and horseshoe kidneys was analyzed.
- Patients presented with varying degrees of obstruction and symptoms, with left-sided UPJO being more common.
- Diagnostic imaging, including ultrasonography, CT, DMSA, and DTPA scans, was utilized for diagnosis and functional assessment.
Findings:
- Laparoscopic pyeloplasty was performed in all cases, with a mean operative time of 198 minutes.
- Common anatomical variations included crossing vessels (50%) and high ureteral insertion (67%).
- The procedure resulted in clinical and radiological improvement in all patients, with a short hospital stay and minimal morbidity (one case of pyelonephritis).
Implications:
- Laparoscopic pyeloplasty is a safe and feasible surgical option for pediatric UPJO in the context of horseshoe kidneys.
- This minimally invasive approach offers good functional and symptomatic outcomes.
- Further research can explore long-term results and refine surgical techniques for this complex anomaly.
Introduction:
Horseshoe kidney occurs in 1 per 400-800 live births and are more frequently observed in males (M:F 2:1). Ureteropelvic junction obstruction (UPJO) is commonly associated with horseshoe kidneys. The variable blood supply, presence of the isthmus and high insertion of the ureter contribute to this problem.
Case Report:
An asymptomatic 6 year-old boy presented with antenatal hydronephrosis. Ultrasonography and CT scan demonstrated left UPJO associated with a horseshoe kidney. DMSA showed 33% of function on the left side. DTPA showed a flat curve and lack of washout. A left dismembered laparoscopic pyeloplasty was performed after identification of crossing vessels and abnormal implantation of the ureter. After one year, the child is asymptomatic. DTPA demonstrated a good washout curve.
Results:
Our cohort consisted of six patients, five males and one female, with a mean age of 6 years (range 6m-17 years) and a mean follow-up of 3 years. Ureteropelvic junction obstruction was more common on the left side. Symptoms appeared only in 34% of the cases. Mean operative time was 198 minutes (range 120-270 minutes). Crossing vessels were common (observed in 50% patients). High implantation of ureter was seen in 67% patients and intrinsic obstruction in 83%. Surgical difficulties were found in two cases. Hospital stay was 4.3 days (3 to 6 days), with only one patient having a mild complication (pyelonephritis). All cases had clinical and radiologic improvement.
Conclusion:
Laparoscopic pyeloplasty is safe and feasible in children with UPJO in horseshoe kidneys, with good results and minimal morbidity.
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