To review and compare four different surgical approaches for partial nephrectomy of a nonfunctioning moiety in children with upper urinary tract duplication anomalies.
A retrospective review of all pediatric patients who underwent open (OPN), laparoscopic (LPN), robotic (RPN), or laparoendoscopic single site (LESS-PN) partial nephrectomy for the treatment of a nonfunctioning moiety in a duplicated collecting system at two medical centers between 2007 and 2017. Patient demographics, perioperative data, surgical techniques, complications, and results were compared.
A total of 59 pediatric patients underwent partial nephrectomy for an upper urinary tract duplication anomaly during a 10-year period: 24 OPN, 7 LPN, 18 RPN, and 10 LESS-PN. Median age was 16 months (IQR 9-49.7). Median weight was 10.7 Kg (IQR 8.8-16.4). Median EBL was comparable between all minimally invasive approaches, but significantly increased in the open approach. OPN required more narcotics (0.554 mg Morphine equivalent/Kg/day, range 0.03-6.13) and Acetaminophen (72.12 mg/Kg/day, range 0-209.06) than all other groups in the study. Median operating time in OPN (154.5 min, range 108-413) and LESS-PN (140 min, range 65-245) were found to be significantly shorter in comparison to LPN (190 min, range 159-355) and RPN (256 min, range 163-458); (p=0.03, 0.005, 0.02, 0.005).
Minimally invasive approaches (LPN, RPN, and LESS-PN) for partial nephrectomy in upper urinary tract duplication anomalies may be associated with decreased postoperative analgesia requirements, shorter hospital stay, less blood loss, and less use of drains in comparison to the open approach, while demonstrating efficacy and safety.
Urology. 2018 Nov 23 [Epub ahead of print]
Amos Neheman, Eyal Kord, Andrew C Strine, Brian A VanderBrink, Eugene A Minevich, William R DeFoor, Pramod P Reddy, Paul H Noh
Department of Urology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel., Department of Urology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel. Electronic address: ., Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.