Pediatric Urology

[zap_stew]

My daughter has had all the tests. Her left kidney has severe hydronephrosis. Her last Meg3 test showed that the functionality has gone down about 8%. Doctor wants to do surgery. He is thinking laparoscopic pyeloplasty, 6 hour surgery. I'm scared. I can't find any articles, etc on this surgery on infants. What is the "normal" age for open pyeloplasty? Please share your experience on either surgery.

[rmbyvoets]

I did find this online. Hope it helps. http://www.ucsfchildrenshospital.org/childrens/medical_services/urology/hnephrosis/pyeloplastyFAQ.html
I dont know where you live but we went to Chicago. Childrens Memorial and Chicago Childrens Comar Hospital are both great.
My daughter is now 5yrs old and having problems again. She was diagnosed with Bi-lateral Hydronephrosis before birth. She had bi-lateral UPJ obstruction. They did a different kind of sugury then that kinda of stretched the tubes out. They told me by the time she was five she would probably have more problems and they were right. Hope all is well and Hope that helps. I pray for you and your little girl.

[zap_stew]

Thanks for the post. I have read three articles now, and we are going forward with laparoscopic. March 26, in Austin, Texas. I'll post a message after it all goes perfectly.... thanks for the prayers.

[scaredmom]

My daughter is 5 1/2 mns old, and we are scheduled for surgery on April 28th. I don't know exactly what he is doing. I thought he said uteral reimplantation. What does your daughter's surgery consist of? My baby has garde 4 hydronephrosis and two ureters. One narrows where it enters the kidnay. She has been on antibiotics since birth and has now developed a rash all over her body--I think she is reacting to the Septra. What meds do they have your baby on? Ever heard of Furadantin? The Dr wants me to put her on it now. I'm nervous about the meds. Please let me know more. I'm so scared and upset. I will pray for your little angel, too.

[zap_stew]

Our angel's surgery is over. The procedure took 7.5 hrs laparoscopically. The first part of the procedure was to use a scope to determine exactly what was going on. Her ureter was constricted right below the renal pelvis, or in plain English, her ureter was really narrow where it connected to the kidney. The narrow part was cut and reattached. Let me describe what I mean by "cut". The detached the ureter and cut it down the middle, like flaying it. They then sewed this part to the open renal pelvis. A stint was placed and will remain for 6-8 weeks. It will be removed during a day surgery. She will be under about 30 minutes. No hospital stay required.

Meds - She has been on the generic form of Bactrim since birth.

Ask lots of questions. We were originally told that we wouldn't be able to tell she even had surgery and that within an hour after she would be drinking pedilite. Well, truth be told, she didn't wake-up until she was in her room, five hours after the surgery was over. She took pedilite immediately upon waking-up because she was starving. She was extremely pale and limp for a good 12 hours after she came out of surgery. The pain meds were not given regularly after surgery. She started vomiting and running a fever on day two. Our doctor ordered a sonogram, to make sure the stint hadn't moved, and an x-ray to make sure urine was not leaking. Both came back fine. BUT - if my husband and I weren't persistent, those tests would not have been run. She was given suppositories to assist with her bowl movements because of the meds as well as the gas from having surgery. It took a good three days for our little one to be quizi - normal. You can definitely tell she had surgery.

Again - ask questions - and DEMAND answers. I'll post three articles shortly that may help you out.

[zap_stew]

One of four articles about this surgery in children less than a year old -


1: J Urol. 2007 Oct;178(4 Pt 2):1791-5; discussion 1795. Epub 2007 Aug 17. Links

Which is better--retroperitoneoscopic or laparoscopic dismembered pyeloplasty in children?
Canon SJ, Jayanthi VR, Lowe GJ.

Section of Urology, Columbus Children's Hospital, Ohio State University , Columbus , Ohio 43205 , USA . canons@chi.osu.edu

PURPOSE: Groups at multiple institutions have documented the efficacy of minimally invasive repair of ureteropelvic junction obstruction with a retroperitoneoscopic or laparoscopic approach. To our knowledge no group has compared the 2 operative procedures directly at a single institution. MATERIALS AND METHODS: The records of 49 consecutive patients with a history of retroperitoneoscopic pyeloplasty or transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction were reviewed retrospectively, of whom 29 underwent attempted retroperitoneoscopic pyeloplasty and 20 underwent laparoscopic pyeloplasty. Retroperitoneoscopic pyeloplasty cases were performed first in the series before changing to the laparoscopic pyeloplasty approach. Retroperitoneoscopic pyeloplasty was performed using an anterolateral approach with retroperitoneal balloon distention. Laparoscopic pyeloplasty repair was performed using a transmesenteric approach for left ureteropelvic junction obstruction or after right colon mobilization for right repairs. Dismembered pyeloplasty was performed over a stent using 5-zero polydioxanone suture. Stents were placed antegrade or retrograde based on anatomy and presenting symptoms. Parameters studied were patient age, operative time, postoperative analgesic requirement during hospitalization, hospital stay and success rate. RESULTS: No difference was observed between the 2 groups in patient age, success rate, hospital stay or analgesic narcotic requirement. Average operative time for retroperitoneoscopic pyeloplasty was significantly longer than for laparoscopic pyeloplasty (239.1 vs 184.8 minutes). Overall success rates were also statistically equivalent (25 of 27 retroperitoneoscopic and 19 of 19 laparoscopic pyeloplasties) with incomplete followup in 1 patient in the retroperitoneoscopic pyeloplasty group and 1 in the laparoscopic pyeloplasty group. Three children, including 2 with retroperitoneoscopic and 1 with laparoscopic pyeloplasty, had transient urinary extravasation postoperatively, which was related to poorly positioned stents. Five patients in the retroperitoneoscopic group and 1 in the laparoscopic group underwent balloon dilation for indistinct but persistent postoperative flank pain with equivocal radiological findings. There were no major complications following either technique. CONCLUSIONS: In our experience no major difference exists between the retroperitoneoscopic and laparoscopic approaches for correcting ureteropelvic junction obstruction. The difference in operative time likely reflects the learning curve for laparoscopic suturing and dissection. Currently we prefer the laparoscopic approach because of the larger working space for suturing, the perceived ease of antegrade stent placement and the subjective improvement in cosmetic outcome. The 2 techniques should be considered equal with regard to the successful correction of ureteropelvic junction obstruction.

PMID: 17707427 [PubMed - indexed for MEDLINE]

[scaredmom]

Sounds like a very hard experience. I'm not looking forward to it--just a few more days. Is your baby doing okay now? I appreciate you sharing your experince with us. How long were you in the hospital with the baby? I will continue to keep your family in our thoughts. I hope all is well and you don't have to go through that ever again. I'm counting down the minutes until surgery on Monday. Thanks again for your help.

[zap_stew]

Our little one is much better now. She still has discomfort from the stint at night, but during the day she is back to normal activity.

I thinking and praying about you and your family today. I sincerely hope you have a positive experience. Our time was fine, in hindsight, it could have been so much worse.

God bless you all!

[scaredmom]

I've been thinking about your little one and family. Our little girl finally seems to be feeling well. However, I had a post surgery ultrasound the other day and the kidney still looked black/filled with fluid. The radiologist wouldn't tell me anything. I have to wait to hear from the DR, and the wait is driving me crazy--he is in a neighboring state. Have you had any u/s since surgery? What did they look like to you? Thank you for all your help. It is nice to have someone else to share this horrible experience with.