Paediatric nephrectomy: Patterns, indications and outcome in a developing country

Abstract

BackgroundPatterns of and indications for nephrectomy vary in different age groups, geographical locations and time periods. In some series nephrectomies were mainly for malignant conditions while in others they were predominantly for non-malignant conditions. Such data on patterns, indications, and outcomes of nephrectomy in children is limited in our environment.ObjectivesTo evaluate nephrectomy in childhood at the Sub-Department of Pediatric Surgery University of Nigeria Teaching Hospital, Ituku/Ozalla Enugu with a focus on pattern, indications, and outcome.Materials And MethodsMedical records of all patients aged =16years who had nephrectomy from January 2007 to December 2016 were studied with emphasis on age, sex, side of nephrectomy, duration of symptoms before presentation, indication for nephrectomy, in-hospital complications, length of hospital stay, in-hospital mortality. SPSS version 15 was used for data entry and analysis.ResultsThere were 52 nephrectomies in 32 males and 20 females. They were for 35 malignant and 17 non-malignant conditions. Most of the malignancies were Wilms tumour (34/35) while non-malignant conditions were late-presenting pelvi-ureteric junction obstruction (9), large multi-cystic dysplastic kidneys (4), renal trauma with pedicle avulsion (1), posterior urethral valve with atrophic kidney (1), duplex system with nonfunctioning upper pole moiety (2). Mean age at nephrectomy was 5.10±3.66 years (range 7 weeks to 16 years); 59% of the nephrectomies were on the left and 41% on the right. Mean duration of hospital stay was 31.78±16.59 days (range 7–66 days). In-hospital mortality rate was 5.8%.ConclusionsIn our unit, nephroblastoma is the main indication for pediatric nephrectomy and were the only indications in females; neglected pelvi-ureteric junction obstruction was the major non-malignant indication and occurred only in males; most nephrectomies were done in the age range of 1–5 years; nephron-sparing nephrectomy, major morbidity, re-operation are uncommon and in-hospital mortality from nephrectomy is still high at 5.8%.

Nephrectomy in Children: A Single Center Experience

“…One study from Enugu, Nigeria reported that nonmalignant indications for nephrectomy were more in females [2]. Our patients' mean age of 6 years is consistent with the report of Bouhafs et al but at variance with the report of Sammond et al [13,14].…”

“…In the present study, there were more nephrectomies in males than in females. Other series on pediatric nephrectomy also reported this male predominance [2,11]. However, other studies documented more nephrectomies in females [7,12].…”

“…Recurrent urinary tract infections, hypertension and abdominal pain resulting from nonfunctional nephroureteral units may be an indication for nephrectomy [1]. The non-malignant pathological conditions that may necessitate nephrectomy in children may include congenital dysplasia, chronic destructive infective processes, chronic obstructive uropathy/nephropathy and severe kidney trauma [2].…”

Obstructed Right Upper Moiety in a Bilateral Partial Duplex Renal System in an Adult

“…The observed obstruction in this patient must have been of long standing, considering the extent of destruction of the parenchyma of the corresponding renal moiety. Such late presentation with non-functioning corresponding renal moiety necessitating heminephrectomy has been reported in our environment, but mostly in children (10). In the absence of any significant renal tissue in the grossly hydronephrotic upper renal moiety, excision of the redundant hydronephrotic sac with the dilated ureter poses no major challenge.…”

Tumor de Wilms: Estudio de Centro Único de Los Andes Ecuatorianos. Serie de Casos con Seguimiento

“…La cirugía es el tratamiento de elección. Está contraindicada cuando el tumor infiltra la vena Cava, o cuando sobrepasa la línea media del abdomen (por el riesgo de que se rompa y contamine la cavidad abdominal) (Ezomike et al, 2018). A 21 pacientes (58,3 %) se les realizó CI, y cuando se sumaron los pacientes con QTNA fueron intervenidos 33 pacientes (91,67 %).…”