Ces Urol 2024, 28(3):158-165 | DOI: 10.48095/cccu2024019

Laparoscopic ureteropyelostomy in children - the technique and long-time experiences

Josef Sedláček¹, Radim Kočvara¹, Marcel Drlík¹, Zuzana Jirásková¹, Lucie Vávřová¹, Eva Faltusová^{1, 2}, Zdeněk Dítě¹

¹ Oddělení dětské urologie, Urologická klinika VFN a 1. LF UK, Praha

² Klinika dětské chirurgie a traumatologie, Thomayerova nemocnice, Praha

Sedláček J, Kočvara R, Drlík M, Jirásková Z, Vávřová L, Faltusová E, Dítě Z. Laparoscopic ureteropyelostomy in children - the technique and long-time experiences.

Aim: Laparoscopic ureteropyelostomy (UPS) represents alternative method in treatment of duplex kidney anomalies with preserved function of upper pole moiety, where the heminephrectomy is risky or impossible. We present long-time experiences with this technique.

Materials and methods: Retrospective evaluation of 35 patients after UPS done between 2011 and 2023. In 3 cases we performed surgery because of hydronephrosis of lower moiety in patients with incomplete duplication. Remaining cases (32) were operated because of complete duplication. With ectopic megaureter in 23 cases, with ectopic ureterocele in 9. Laparoscopic operation was recommended in children older than one year, minimally 10 kg, significant kidney dilatation, no reflux and preserved upper segment function. We evaluated age of patients, operating time, success rate, follow up and complications.

Results: Median age was 29 (14-184) months, median operating time 210 (110-320) minutes. In all patients decreased or vanished upper tract dilatation. Median follow up was 18 (5-120) months. No reoperations were recorded. The most frequent complication was urinary leak from anastomosis in 7 (20%) cases. The reason was failure of urine diversion in 5 children (2 nephrostomy failure, ureteral catheter dysfunction in 3), remaining 2 patients were operated without urine diversion. Complications were resolved by ureteral catheter insertion in 3 and ureteral stent insertion in 4 cases.

Conclusion: Laparoscopic UPS represents alternative mini-invasive method in duplex kidney anomalies treatment. It has high success rate and low rate of complications. The most frequent problem is urine leak from anastomosis. Therefore, the choice of reliable urine diversion is critical.

Keywords: Duplex kidney, megaureter, uretero-pyelostomy, laparoscopy, children.

Received: June 10, 2024; Revised: June 30, 2024; Accepted: July 22, 2024; Prepublished online: July 22, 2024; Published: October 1, 2024