Objectives: To describe our experience with pediatric laparoscopic nephrectomy (LN) and laparoscopic nephroureterectomy (LNU) for giant hydronephrosis.
Methods: A 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.
Results: Three 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.
Conclusions: Although 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.