Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report

Abstract

BACKGROUND Renal duplication is a common deformity of the urinary system, with an incidence of approximately 1/125 in children. Symptomatic patients with hydronephrosis, vesicoureteral reflux, or incontinence may require surgical interventions. Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy. CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney. Ultrasonography showed that the left kidney was larger, approximately 12.6 cm × 6.3 cm × 5.5 cm in size, with visible separation of the pelvis and an obviously separated lower portion. The upper segment of the left ureter was dilated (approximately 2.6 cm in width), and no significant dilation was observed in the middle and upper segments. The right kidney and ureter were normal. Primary diagnosis was left renal duplication malformation and hydronephrosis. Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed. Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney. The upper left kidney was smaller than normal, and the pelvis and ureter were larger than normal. The renal artery was blocked for 40 min. A hemolock was used to clamp down the kidney ureter, and a drainage tube was retained in the retroperitoneal cavity. The operation was uneventful, and the estimated amount of blood loss was 100 mL. Total abdominal drainage amount was 116 mL. The drainage tube was removed on postoperative day (POD) 3 and the patient was discharged on POD6. The pathological diagnosis confirmed the atrophy of the renal parenchyma, the dilation of the renal pelvis, hydronephrosis, and ureteral cystic dilation. CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.

Renal artery embolization in the treatment of urinary fistula after renal duplication: A case report and review of literature

“…According to the Meyer-Weigert rule, the clinical symptoms of duplication of kidney deformity are often related to the superior kidney. The suitable surgical treatment is heminephrectomy[ 8 ]. Since the right upper kidney of this patient had normal function, heminephrectomy was performed for the right lower kidney.…”

Retroperitoneoscopy in the horse: Anatomical study of the retroperitoneal perirenal space and description of a surgical approach

“…Retroperitoneoscopy could offer a new surgical approach to the kidneys and perirenal structures, avoiding contamination of the peritoneal cavity in case of renal abscess or tumor 8,9 . Another advantage of retroperitoneoscopy is that postoperative urine leakage and bleeding are confined to the retroperitoneum 23 . Using a dorsal approach to the kidney, initial ligation of the renal artery branches could be easily performed and would reduce renal flow and prevent congestion.…”