Laparoscopic treatment of hydronephrosis in children with the horseshoe kidney: description of a case series

Abstract

Introduction. The present research is a case series of laparoscopic treatment of pyeloureteral obstruction in 3 patients with a horseshoe kidney.

Material and methods. Laparoscopic treatment of hydronephrosis in three patients with the horseshoe kidney was performed by one surgeon (2 boys, 1 girl). Preoperative computed tomography confirmed the diagnosis and found a source of hydronephrosis – obstruction of the pyeloureteral segment. At laparoscopy, the horseshoe kidney anatomy was finally defined and the cause of the obstruction of the pyeloureteral segment was found too - high ureteral transposition from the pelvis or an aberrant vessel. Pyeloplasty performed by Anderson-Hynes technique was a final stage of the treatment.

Results. The lesion of the left kidney half was noted in 2 cases, of the right one – in 1 case. All three interventions were successfully performed laparoscopically without conversion to open surgery. Duration of surgical intervention varied from 60 to 90 minutes. Mean operative time was 75.0±15.0 min (median – 75.0 [67.5; 82.5] min). Average stay in ICU was 19.3±4.2 hours (median – 18.0 [17.0; 21.0] hours) with the longest interval being 24 hours in a younger patient due to tracheal decannulation problems .

The anteroposterior diameter of the pelvis was measured before surgery and 6 months after surgery. It was found that all patients had reduction in the pelvis size in average from 43.3±11.5 mm to 8.0±2.0 mm (median – 50.0 [40.0; 50.0] mm and 8.0 [7.0; 9.0] mm, respectively). Patients also showed a positive trend in the restoration of blood flow in the affected segment of the kidney. Resistance index changes were in averaged from 0.70±0.02 to 0.62±0.02 (median – 0.71 [0.70; 0.72] and 0.62 [0.61; 0.63], respectively).

Conclusion. Surgical treatment of hydronephrosis in patients with the horseshoe kidney is a complex problem, mainly because of the altered renal anatomy and variety of triggers that may cause hydronephrosis. Laparoscopic pyeloplasty is obviously a universal way to treat the discussed pathology.

Keywords

horseshoe kidney / hydronephrosis / pyeloplasty / laparoscopy / children

References

[1] Ram A.D., Thomas R.E., Malone P. A new operative technique for a rare case of pyelic fusion. J Pediatr Urol. 2011; 7(5): 574–5.

[2] Gonzalez F., Canning D.A., Hyun G., Casale P. Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems. BJU Int. 2006; 97: 161–5.

[3] Natsis K., Piagkou M., Skotsimara A., Protogerou V., Tsitouridis I., Skandalakis P. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat. 2014; 36: 517–526.

[4] Faddegon S., Granberg C., Tan Y.K., et al. Minimally invasive pyeloplasty in horseshoe kidneys with ureteropelvic junction obstruction: a case series. Int Braz J Urol. 2013; 39: 195–202.

[5] Blanc T., Koulouris E., Botto N., et al. Laparoscopic pyeloplasty in children with horseshoe kidney. J Urol. 2014; 191: 1097–103.

[6] Shadpour P., Akhyari H.H., Maghsoudi R., Etemadian M. Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options. Can Urol Assoc J. 2015; 9: 775–9.

[7] Oderda M., Calleris G., Allasia M., Dalmasso E., Falcone M., Catti M., Merlini E., Gontero P. Robot-assisted laparoscopic pyeloplasty in a pediatric patient with horseshoe kidney: surgical technique and review of the literature. Urologia. 2017; 84: 55–60

[8] Moscardi P.R., Lopes R.I., Mello M.F., Barbosa C.M. Neto, Cezarino B.N., Oliveira L.M., Dénes F.T., Srougi M. Laparoscopic Pyeloplasty in children with Horseshoe Kidney. Int Braz J Urol. 2017; 43(2): 375.

[9] Bleve C., Bucci V., Conighi M.L., Battaglino F., Costa L., Fasoli L., Zolpi E., Chiarenza S.F. Horseshoe kidney and uretero-pelvic-junction obstruction in a pediatric patient. Laparoscopic vascular hitch: A valid alternative to dismembered pyeloplasty? Pediatr Med Chir. 2017; 39(4): 178.

[10] Esposito C., Masieri L., Blanc T., Manzoni G., Silay S., Escolino M. Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study. World J Urol. 2019; 37(10): 2257–63.

[11] Ieiri S., Nagata K. Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney. Surg Case Rep. 2021; 7(1): 103.

[12] Khan A., Myatt A., Palit V., et al. Laparoscopic heminephrectomy of a horseshoe kidney. J Soc Laparoend Surg. 2011; 15: 415–20.

[13] Rossi U.G., Romano M., Ferro C. Seven renal arteries. Clin Anat. 2006; 19: 632-3.

[14] Bamac B., Colak T. Bilateral accessory renal arteries with retroaortic left renal vein: report of an elderly cadaver case. Clin Anat. 2006; 19: 714-5.

[15] Boatman D.L., Cornell S.H., Kolln C.P. The arterial supply of horseshoe kidneys. Am J Roentgenol Radium Ther Nucl Med. 1971; 113: 447–51.

[16] Janetschek G., Peschel R., Altarac S., Bartsch G. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology. 1996; 47: 311–6.

[17] Mostafavi M.R., Prasad P.V., Saltzman B. Magnetic resonance urography and angiography in the evaluation of a horseshoe kidney with ureteropelvic junction obstruction. Urology. 1998; 51: 484–6.

[18] Esposito C., Masieri L., Blanc T., Musleh L., Ballouhey Q., Fourcade L., Escolino M. Robot-assisted laparoscopic pyeloplasty (RALP) in children with complex pelvi-ureteric junction obstruction (PUJO): results of a multicenter European report. World J Urol. 2021; 39(5): 1641–7.

RIGHTS & PERMISSIONS

Kozlov Y.A., Poloyan S.S., Marchuk A.A., Rozhanski A.P., Byrgazov A.A., Kovalkov K.A., Ochirov C.B., Kapuller V.M., Narkevich A.N.