Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys

OBJECTIVES To report our experience with laparoscopic heminephrectomy (LHN) in children with duplex kidneys, highlighting the late outcomes, including anatomical and functional aspects. PATIENTS AND METHODS We retrospectively analysed the medical records of 17 children (18 renal units) with duplex kidneys who underwent LHN (15) and heminephroureterectomy (three). Before surgery, all patients were evaluated using ultrasonography, voiding cysto-urethrography, computed tomography or magnetic resonance imaging with urography, and nuclear scintigraphy. After surgery patients were evaluated using ultrasonography and nuclear scintigraphy, and by voiding cysto-urethrography if there was a refluxing ureter. RESULTS All laparoscopic surgery (17 transperitoneal and one retroperitoneal approach), were completed as planned with no intraoperative complications. Complications after surgery included prolonged urine leakage from a refluxing ureteric stump in one heminephroureterectomy, and a complete functional loss of the remnant pole in one retroperitoneal LHN. The function of the remnant pole was preserved in 17 patients (94%); in these 17 the mean decrease in renal function was 2.8%. Follow-up ultrasonography showed asymptomatic cystic structures in six patients. There was an asymptomatic remnant ureteric stump in two cases (one refluxing, one nonrefluxing). CONCLUSION The loss of function caused by surgery is subtle but some remnant pole will be fully lost while experience is gained. Because the functional impairment due to vasospasm or vascular injury might not be recognized, all remnant kidneys must be evaluated using postoperative nuclear scintigraphy.