Laparoscopic Pyeloplasty in children with Horseshoe Kidney

Abstract

_______________________________________________________________________________________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. ARTICLE INFO

Hydronephrosis in pediatric horseshoe kidneys: a comparative analysis of open and laparoscopic pyeloplasty and the influence of obstruction causes

“…In our study, structural abnormalities causing hydronephrosis included intrinsic obstruction, crossing vessels, high ureteral insertions, and kinking ureter. In the overall cohort, intrinsic obstruction was the most common cause of obstruction, which was consistent with previous report ( 21 ). Previous literature has reported that crossing vessels occurrence in 40–80% of patients, and high ureteral insertions in 20–40% ( 5 , 6 , 22 ).…”

“…Our study demonstrated a surgical success rate of 80.6% (25/31) in treating HSK. Previous studies have reported success rates of pyeloplasty for HSK to be lower compared to that of normal kidneys, ranging from 55% to 80% and exceeding 90%, respectively ( 7 , 11 , 21 , 26 ). Moreover, previous study has shown no significant difference in success rates among OP, LP, and robot-assisted LP for treating hydronephrosis in HSK ( 12 ).…”