Initially, laparoscopy had limited diagnostic and therapeutic uses. With the advent of automatic clip appliers, stapling devices, impermeable organ removal bags, and morcellating devices, the scope of procedures that can be performed laparoscopically has been broadened substantially. In urology, such advances have allowed for laparoscopic varicocelectomies, bladder augmentations, urinary diversions, ureterolysis, adrenalectomies, nephrectomies, and nephro-ureterectomies. We now have performed over 50 laparoscopic nephrectomies on children at our center. Our director, Dr. Dix Poppas, has performed all the operations.
Some of the indications for nephrectomy have included large painful, multicystic dysplastic kidneys, poorly controlled renovascular hypertension, and a non-functioning kidney secondary to severe vesicoureteral reflux. Other children treated with this procedure have presented with urinary tract infections in the setting of non-functioning kidneys secondary to congenital UPJ obstructions. In one of these children (a one-year old girl), a horseshoe kidney was discovered with a non-functioning right kidney secondary to UPJ obstruction.
We have also performed laparoscopic nephro-ureterectomies on children. In this case, we remove the kidney and the entire ureter. The ureter is the muscular tube that drains urine into the bladder from the kidney. Several of these children presented with non-functioning kidneys secondary to severe vesicoureteral reflux. Reflux is a condition described elsewhere on our web site. In short, reflux allows the passage of infected urine into the kidney through the ureter. This can result in chronic infection and scarring of the kidney leading to unilateral and sometimes bilateral infections. The burned-out scarred kidneys that continue to have infections must be removed.
We have also performed partial nephrectomies with ureterectomy on several children. These patients presented with urinary tract infections and were found to have duplicated collecting systems. In this situation we were able to separate the nonfunctioning portion of the duplicated kidney from the normally functioning portion in order to preserve future kidney function.