Abstract
Introduction
The lateral approach is more widely used in retroperitoneoscopic (RP) heminephroureterectomy
(HNU) due to familiar orientation and ease of conversion. The prone approach however
gives early and easy access to the vascular pedicle. The main reason for not adopting
a prone approach more widely is the perceived difficulty in lower ureteric access.
We present a series of 30 HNUs where the prone approach was utilized extremely effectively
with no conversions and few complications.
Methods
Thirty consecutive HNUs performed over a 4-year period (2004–2007) using a prone RP
approach were included in the study. Prospectively recorded data and notes were reviewed.
Results
Upper HNU was done in 17 and lower HNU in 13 patients. Mean age was 3.2 years (range
0.9–13.3). There were no transfusions or conversions. Follow-up ultrasound showed
healthy remnant moieties in all. Residual ureteric stump was seen in six patients
but only one was symptomatic requiring a further procedure.
Conclusion
With the prone approach the anatomy can be demonstrated quickly and effectively. Dissection
can be done easily without the need for kidney retraction as gravity aids demonstration
of the renal vascular pedicle. There is a low risk of complications arising from the
residual ureteric stump. We recommend that this approach be considered for RP HNU
in all patients, irrespective of age.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laparoendoscopic upper pole partial nephrectomy with ureterectomy.J Urol. 1993; 150: 940-943
- Retroperitoneoscopic partial nephrectomy in infants and children.J Pediatr. 1998; 3: 646
- Renal surgery via a retroperitoneal approach in children.J Urol. 1998; 160: 1138-1141
- A comparison of the lateral and posterior retroperitoneoscopic approach for complete and partial nephroureterectomy in children.BJU Int. 2001; 87: 517-520
- Selective approach for transperitoneal and extraperitoneal endoscopic nephrectomy in children.J Urol. 2004; 171: 814-816
- Laparoscopic heminephrectomy in infants and children: first 54 cases.J Pediatr Urol. 2007; 3: 100-103
- Laparoscopic nephrectomy in children: systematic review of transperitoneal and retroperitoneal approaches.Urology. 2009; 73: 280-284
- Retroperitoneoscopy: the balloon technique.Ann R Coll Surg Engl. 1994; 76: 259-263
- Outcome analysis of retroperitoneal laparoscopic heminephrectomy in children.J Urol. 2006; 175 (discussion 2280–2): 2277-2280
- Laparoscopic management and outcomes in non-functioning moieties of duplex kidneys in children.J Pediatr Urol. 2009 May 8; ([Epub ahead of print])
- Transperitoneal and retroperitoneal laparoscopic heminephrectomy – what approach for which patient?.J Urol. 2006; 176 (discussion 2639): 2636-2639
- Management of ectopic ureters: experience with the upper tract approach.J Urol. 1997; 158: 1245-1247
- Natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy for vesicoureteral reflux.J Urol. 1998; 160: 1026-1027
- Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction.BJU Int. 2001; 88: 586-589
Article info
Publication history
Published online: September 07, 2009
Accepted:
July 29,
2009
Received:
June 22,
2009
Identification
Copyright
© 2009 Journal of Pediatric Urology Company. Published by Elsevier Inc. All rights reserved.
