ENDOUROLOGY & LAPAROSCOPY

Laparoscopic Dismembered Pyeloplasty in Children Younger Than 2 Years
Cascio S, Tien A, Chee W, Tan HL
Department of Pediatric Surgery, Women’s and Children’s Hospital, and University of Adelaide, North Adelaide, South Australia
J Urol. 2007; 177: 335-8

• Purpose: Since the first laparoscopic pyeloplasty was described in a child in 1995, there have been several reports of pyeloplasty in older children. However, to date there have been few reports of laparoscopic pyeloplasty in infants and toddlers. The aim of this study was to evaluate the results of laparoscopic pyeloplasty in children younger than 2 years.
• Materials and Methods: All laparoscopic Anderson-Hynes pyeloplasties performed in children younger than 2 years were retrospectively reviewed. The diagnosis of ureteropelvic junction obstruction was confirmed on renal sonography and diuretic renogram. Laparoscopic pyeloplasties were performed via a transperitoneal route as originally described, with key modifications. All children were investigated with postoperative diuretic renogram and renal ultrasonography.
• Results: A total of 38 children with ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes Pyeloplasty between January 2001 and December 2005. Of these patients 11 (7 males and 4 females) were younger than 2 years at surgery (median 1.4, range 2 to 22 months) and 1 had bilateral ureteropelvic junction obstruction, for a total of 12 primary repairs. However, 2 patients (17%) required redo laparoscopic pyeloplasty, for a total of 14 laparoscopic dismembered pyeloplasties in this age group. Operative time ranged from 70 to 140 minutes (mean 100) and median hospital stay was 2 days. Followup studies showed normal drainage in all patients except 1, who after redo pyeloplasty exhibited significantly improved but still prolonged drainage.
• Conclusions: This study suggests that laparoscopic pyeloplasty can now be performed in young children with good results.
  
  
• Editorial Comment
  Laparoscopic Pyeloplasty still remains controversial in the pediatric population. The new era of reconstructive surgery with better laparoscopic knowledge and instrumentation, i.e.; fine needlescopic (minilaparoscopic) instruments, facilitated the ease of executing a precise and delicate reconstructive surgery, allowing surgeons to perform the anastomosis without handling or traumatizing the ureter or pelvic mucosa.
  In a retrospective study, the authors evaluated their experience of 14 laparoscopic dismembered pyeloplasties performed in patients less than 2 years-old. The data demonstrated feasibility of this surgical technique with a good outcome measured objectively by nuclear renal lasix scan but with no subjective evaluation (pain free postoperatively).

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA