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Khirurgii

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Year 2021 Vol. 29 No 1

UROLOGY

V.I. DUBROV 1, 2, A.V. STROTSKY 2

THE RESULTS OF LAPAROSCOPIC HEMINEPHRURETERECTOMY AND URETEROPYELOANASTOMOSIS (URETEROURETEROANASTOMOSIS) FOR DUPLEX KIDNEY IN CHILDREN

The 2nd City Children's Clinical Hospital 1,
Belarusian State Medical University2, Minsk
The Republic of Belarus

Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children.
Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median – 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole – in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) – in 34 (33.3%).
Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,0±46,2 minutes (median – 120 minutes); in LUPS(LUUS) – 160,1±44,7 minutes (median – 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, Clavien–Dindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%).
Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.

Keywords: laparoscopy, duplex kidney, heminephrectomy, ureteropyelostomy, ureteroureterostomy
p. 53-61 of the original issue
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Address for correspondence:
220020, Republic of Belarus,
Minsk, Narochanskaya Str. 17,
the 2nd City Children’s Clinical Hospital,
the Urology Department,
Tel. +375 29 674-42-49,
e-mail: dubroff2000@mail.ru,
Dubrov Vitaly I.
Information about the authors:
Dubrov Vitaly I., PhD, Head of the Urology Department, the 2nd City Children’s Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3705-1288
Strotsky Alexander V., MD, Professor, Head of the Urology Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1640-5857
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