Laparoscopic retroperitoneal versus open nephrectomy in children: a comparative study

Nephrectomy, nephroureterectomy and heminephroureterectomy for congenital anomalies are common procedures in the pediatric urological practice. The use of laparoscopy in such procedures is claimed to be an excellent alternative to the classical open technique, and is rapidly becoming the gold standard, laparoscopy could be performed through either a transperitoneal or a retroperitoneal approach. The aim of this study was to compare the laparoscopic retroperitoneal nephrectomy technique in children with its open counterpart. Between August 2003 and August 2005; 13 cases [mean age 4.5 years [range 2-14 years]] were operated upon in our department using the laparoscopic retroperitoneal technique: four heminephroureterectomies [double system with or without ureterocele], four nephroureterectomies [two posterior urethral valves and two vesico-ureteric reflux cases] and five simple nephrectomies [one multicystic dysplasti kidney, one neglected uretero-pelvic junction obstruction, one pyonephrosis and two refluxing non functioning kidneys]. The procedure was performed using a 3-port technique [two 5mm and one 10 mm ports]. This peri and postoperative data of this group was compared retrospectively to a similar group of 10 patients who underwent open nephrectomies during the same period. The mean follow up was 9 months [range 4-18 months]. In the laparoscopic group, the mean operative time was 145 minutes [range 90-180 minutes] and no blood transfusion was needed. There was no need for intravenous analgesia except in one patient. Bowel movement was recovered between 6 and 8 hours [mean 7 hours] postoperatively. The drain was removed after 12 to 16 hours [mean 12 hours] and children were discharged after 24 to 36 hours [mean 24 hours]. One heminephroureterectomy was converted to an open technique [due to technical problems]. Two cases were completed by the transperitoneal route [one nephrectomy with previous percutaneous nephrostomy and one heminephroureterectomy] due to difficulty to create/loss of the laparoscopic retroperitoneal space. In the open surgery group, the mean operative time was 105 minutes [range 60-130 minutes] and no blood transfusion was needed. Intravenous analgesia was necessary in 8 children. Bowel movement was recovered 12 to 18 hours postoperatively [mean 12 hours]. The drain was removed 48 to 120 hours postoperative [mean 72 hours] and children discharged after 3 to 5 days [mean 3 days]. Laparoscopic retroperitoneal nepherectomy, nephroureterectomy and heminephroureterectomy in children are feasible, safe and provide an excellent alternative to open surgery. The retroperitoneal approach may even be superior to the transperitoneal approach; however, large numbered studies are needed to confirm this

Laparoscopy assisted versus standard inguinal orchiopexy for high palpable undescended testes

In high palpable undescended testes, many surgeons perform inguinal orchiopexy routinely. Some surgeons prefer a totally laparoscopic approach. Technically, this is not always possible. However, laparoscopy could still be valuable in dissecting the testicular pedicle before proceeding to the standard inguinal orchiopexy. The purpose of this study was to evaluate the advantages of such strategy. The study included thirty-eight children, with 48 high palpable undescended testes treated by the author over 2 1/2 years. These were divided into two groups. Group [I] comprised 34 high palpable undescended testes, treated by the standard-inguinal orchiopexy without laparoscopy. Group [II] comprised 14 high palpable undescended testes treated by laparoscopy assisted orchiopexy. Both groups were compared with regard to the need to divide the spermatic-vessels, level of fixation of the testis [at the bottom of the scrotum or at a higher level], the need for second stage operation and testicular volume during follow-up. In group [I], 3 cases [8.8%] required sectioning of the spermatic vessels; 8 cases [23.5%] required a second stage, 5 cases [14.7%] had high testicular fixation, and 5 cases [14.7%] showed testicular volume reduction during follow-up. In group [II], only 1 case [7%] required spermatic cord sectioning. In high palpable undescended testes, laparoscopic dissection of the testicular pedicle before standard inguinal orchiopexy is helpful. It gives the length required for bringing the testis into proper scrotalposition, avoids compromising vascularity of the testis or expose cord structures to injury and might completely eliminate the need for a second stage intervention with its potential complications

Congenital ceco-vesical fistula associated with anorectal malformation: Case report

Congenital ceco-vesical fistula [CCVF] associated with high anorectal malformation was not described before. The only described case in 1972 was associated with total colonic atresia which are not the case. We report a case of CCVF associated with a blind ended distal colon in a 50-day old male presented with high imperforate anus faecalurea, and epididymo -orchitis of the left testis. The bladder was separated from the cecum followed by abdomino-perineal pull-through of the colon. The relevant literature is reviewed, and the diagnostic modalities and management are discussed

Outcome of newborns conceived through artificial reproductive techniques in Tehran Iran

Today there is a rise in the number of newborns conceived by artificial reproductive techniques [ART]. Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Prematurity, low birth weight [LBW], very low birth weight [VLBW], twins and triplets, small for gestational age [SGA], need for resuscitation at birth, respiratory distress syndrome [RDS] and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception [p<0.05]. Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age [LGA], congenital pneumonia, necrotizing entrocolitis [NEC], respiratory air leakage syndromes [ALS], hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome [MAS], isseminated intravascular coagulopathy [DIC], cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth

Megalourethra

Megalourethra is a rare congenital anomaly of the anterior urethra. There are two varieties, scaphoid and fusiform. We present a patient, with scaphoid variety, who we repaired in one stage, by tailoring the skin and urethra with a size 12 F catheter, through an elliptical incision, without degloving the penis. Apart from a coronal sulcus urethral fistula, which was repaired 6 months later, the repair was successful. It is concluded that megalourethra, scaphoid variety, can be repaired successfully in one stage, and without much trauma to the penis