Laparoscopic Nephrectomy for Pediatric Giant Hydronephrosis

ObjectivesTo describe our experience with pediatric laparoscopic nephrectomy (LN) and laparoscopic nephroureterectomy (LNU) for giant hydronephrosis.MethodsA retrospective review was conducted of all pediatric patients undergoing a transperitoneal LN or LNU. Five of these patients had giant hydronephrosis in a nonfunctioning kidney. Because of chronic infection and the massive nature of hydronephrosis, the system was internally decompressed with an end-hole stent. Partial decompression provided space in the abdomen for adequate visualization while maintaining enough turgidity to facilitate dissection.ResultsThree LNs and two LNUs were performed in children with giant hydronephrosis. All cases were completed laparoscopically. Vascular anatomy and/or orientation were anomalous in all cases because of mass effect. Mean patient age was 9 years (range, 3 to 17 years). Average surgery time was 281 minutes (range, 225 to 410 minutes), and mean estimated blood loss was 27 mL (range, 5 to 50 mL). Mean time to oral intake was 6.5 hours (range, 4 to 11 hours). All patients were discharged on postoperative day 3, and there were no major or minor complications.ConclusionsAlthough pediatric LN and LNU for giant hydronephrosis present unique challenges owing to the large renal volume in a small abdominal cavity, these procedures can be safely performed with careful attention to the altered anatomic relationships.