Initial experience with laparoscopic ipsilateral ureteroureterostomy in infants and children for duplication anomalies of the urinary tract.

摘要

PURPOSE: We report the feasibility of laparoscopic ipsilateral ureteroureterostomy for duplication anomalies of the urinary tract in infants and children, and the short-term results in 6 patients. MATERIALS AND METHODS: Laparoscopic ipsilateral ureteroureterostomy was performed transperitoneally with 3 and 4 ports for unilateral and bilateral cases, respectively. Cystoscopy, retrograde pyelogram and stent placement in the recipient ureter were performed at the beginning of each case. The anastomosis was carried out with running or interrupted 6-zero sutures. An abdominal drain and Foley catheter were left indwelling in all cases. Demographic data, body measurements, type of procedure and indication, laterality, intraoperative and postoperative complications, analgesia requirement, length of hospitalization and outcome were recorded. RESULTS: Eight laparoscopic ipsilateral ureteroureterostomies were performed in 6 patients (2 males). Mean patient age was 51 months. Diagnoses were bilateral lower pole vesicoureteral reflux (2 patients) and ectopic ureter (4). Mean operative time including cystoscopy was 257 minutes (range 140 to 430) and estimated mean blood loss was 2.7 ml. There were no intraoperative complications. Mean morphine requirement was 0.13 mg/kg. Two cases required acetaminophen only for pain management. All patients were discharged home with no narcotics at a median of 3 days postoperatively (range 1 to 7). There were 2 postoperative febrile urinary tract infections. Followup renal ultrasound demonstrated no significant hydronephrosis of the moieties involved. CONCLUSIONS: In this initial experience laparoscopic ipsilateral ureteroureterostomy was done safely and effectively even in small infants. Postoperative course was uneventful, with negligible blood loss and minimal analgesia requirement, and initial results were comparable to those of open surgery.