Retroperitoneoscopic bilateral nephrectomy and extraperitoneal ureterocystoplasty in a child on peritoneal dialysis.

A 4-year-old boy with posterior urethral valves and end stage kidney disease on peritoneal dialysis presented with high pressure non-compliant bladder with left ureterohydronephrosis. Inability to perform hemodialysis due to patient's weight exclusion, imposed the necessity to preserve peritoneal dialysis. A bilateral nephrectomy by retroperitoneoscopy with extraperitoneal augmentation ureterocystoplasty using left ureter and pelvis associated with continent diversion using right ureter as umbilical stoma was performed followed by kidney transplantation. An excellent outcome with voluntary voiding without CIC is reported eighteen months later. This treatment modality is the best option to manage End Stage Kidney Disease on peritoneal dialysis in those patients.

Development of catheter-based treatment of patent ductus arteriosus: a medium-sized centre experience.

BACKGROUND: Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations. AIM: To describe our initial experience of percutaneous PDA closure. METHODS: Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm (n=50) and a Detachable coil (DC) for smaller ducts (n=23). RESULTS: The diameter of the ducts ranged from 1 to 7.2 (mean 2.9+/-1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later. CONCLUSION: Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.