Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children

The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children. We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications. Thirty-five total and six partial nephrectomies [upper pole] were performed. The mean age was 84 months [7-175]. Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min [60-280]. There were no intraoperative complications [surgical and anesthetic], and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days [1-5]. A drain was used in 12 cases and was removed after a mean of 2 days. Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned

Uronephrological outcomes of patients with neural tube defects

To review the uronephrological outcomes of myelomeningocele [MMC] patients attending a Spina Bifida Clinic. We retrospectively reviewed the medical records of all patients from the combined Spina Bifida Clinic, at King Khalid University Hospital, Riyadh, Saudi Arabia between 1999 and 2009 who had at least one year of follow-up with us. We examined their demographic data, uronephrological status at presentation, most recent follow-up, and the rate of surgical intervention. During the 10-year period, 188 patients were actively followed-up. The mean age at presentation was 5.3 years +/- 3.6 SD. At their last follow-up, 109 patients [58%] were using clean intermittent catheterization, 44[23%] had received BotoxR injections, and 26 [14%] had undergone bladder reconstruction. Most [66%] patients were older than 3 years when they presented to us; this group had a significantly higher rate of surgical intervention [BotoxR or reconstruction] compared with those who came to us earlier [p=0.003 for patients receiving BotoxR injections, and p=0.025 for patients undergoing bladder reconstruction].Our multidisciplinary Spina Bifida Clinic is an integral part of MCC management to reach a safe urological outcome. Early presentations to our clinic resulted in a lesser need for surgical intercession compared with those who presented at more than 3 years old.