Laparoscopic renal surgery in infants and children: is it a feasible and safe procedure for all pediatric age groups?

PURPOSE: Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes. MATERIALS AND METHODS: From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years). RESULTS: Median age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0 percent, 1.4 percent and 1.9 percent for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5 percent, 8.2 percent and 7.8 percent for age groups A to C, respectively (p = 0.88). CONCLUSIONS: Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.

Laparoscopic diagnosis and treatment of nonpalpable testis

INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20 percent of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1 percent) had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88 percent success rate with the 2 stage Fowler-Stephens approach and only 33 percent rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

A litotripsia extracorpórea no tratamento de cálculos urinários em crianças / Extracorporeal lithotripsy for the treatment of urolithiasis in children

Objetivo: cálculos urinários atingem de 5 a 10por cento da população em alguma fase da vida. Destes casos, somente 2 a 3por cento são crianças.O tratamento da litiase urinária na faixa pediátrica, com o uso de métodos minimamente invasivos, representa uma alternativa cada vez mais atraente. O presente trabalho objetiva apresentar resultados de litotripsia extracorpórea como tratamento minimamente invasivo de litiase urinária na infância.Métodos: no periodo de setembro de 1991 a setembro de 2000, foram tratadas e acompanhadas 87 crianças, sendo que seis delas tinham dois cálculos; portanto foram tratados 93 cálculos urinários.Foi utilizado o equipamento de litotripsia extracorpórea por ondas de choque, da Dornier-Philips.Resultados: os cálculos piélicos, caliciais superiores e médios foram fragmentados e eliminados na porcentagem de 87,7por cento e 77,8por cento, respectivamente. Os cálculos localizados no cálice inferior foram eliminados em 64,7por cento. Dos três casos de cálculo coraliforme, somente um ficou livre do cálculo (33,3por cento). Os dez pacientes com cálculo ureteral ficaram livres de litiase (100por cento). Os cálculos vesicais foram tratados e eliminados em 60por cento dos casos.Conclusão: a litotripsia extracorpórea demonstrou ser uma forma eficiente de tratamento de cálculos piélicos, caliciais, ureterais e vesicais...

Ureterocele ortotópica prolapsada: relato de um caso / Orthotopic prolapsed ureterocele

Os autores relatam um caso de paciente feminino com 30 anos de idade, com diagnóstico de ureterocele ortotópica prolapsada, manifestada clinicamente como tumoraçäo vulvar; discutem as várias modalidades de tratamento da uretrocele na literatura