Chronic peritoneal dialysis in children.

The incidence of end-stage renal disease in children is increasing. Peritoneal dialysis (PD) is the modality of choice in many European countries and is increasingly applied worldwide. PD enables children of all ages to be successfully treated while awaiting the ultimate goal of renal transplantation. The advantages of PD over other forms of renal replacement therapy are numerous, in particular the potential for the child to lead a relatively normal life. Indications for commencing PD, the rationale, preparation of family, technical aspects, and management of complications are discussed.

The challenge of maintaining dialysis lines in the under twos.

INTRODUCTION: Hemodialysis (HD) and peritoneal dialysis (PD) are essential adjuncts in the management of children with established renal failure (ERF), but complications are common, particularly in the younger age groups. We reviewed catheter life and catheter-related complications in children who began chronic dialysis before the age of 2 years. METHOD: From the case notes of the children, born between 1990 and 2008, the data gathered included etiology of ERF, age at first dialysis catheter, complications, catheter life, and number of PD and HD. RESULTS: Ninety lines were inserted (40 PD and 50 HD) in 22 children with ERF. Eleven children were aged <6 months when commencing dialysis, six of whom were neonates. PD, the preferred modality, was offered to all but two children. Four children were managed with PD alone. One child died of overwhelming sepsis secondary to PD peritonitis. Average catheter life for HD was 3 months and PD 9.1 months. Luminal blockage and infection were the commonest reasons for change of HD catheters. Peritonitis was the commonest factor leading to PD removal. CONCLUSIONS: Children younger than 2 years can be dialyzed successfully by HD or PD but complications are frequent, leading to >2 catheters in the majority. Chronic dialysis in the very young is achievable and useful, but a high incidence of catheter changes must be anticipated.

Laparoscopic extraction of the awkward intravesical foreign body: a point of technique.

A technique is described to extract intravesical foreign bodies that cannot be safely extracted urethrally. A laparoscopic port is introduced via a small suprapubic incision into a saline distended bladder. The entry into the bladder is guided by visualization through the cystoscope. The foreign body is grasped using a laparoscopic grasper and delivered via the suprapubic incision en masse with the port.