Laparoskopická uretero-pyeloanastomóza u dětí - technika a dlouhodobé zkušenosti

Laparoscopic ureteropyelostomy in children –⁠ the technique and long-time  experiences

Aim: Laparoscopic ureteropyelostomy (UPS) represents alternative method in treatment of du plex kidney anomalies with preserved function of upper pole moiety, where the heminephrectomy is risky or impossible We present long‑time experi ences with this technique Materials and methods: Retrospective eval uation of 35 patients after UPS done between 2011 and 2023 In 3 cases we performed surgery because of hydronephrosis of lower moiety in patients with incomplete duplication Remaining cases (32) were operated because of complete duplication With ectopic megaureter in 23 cases, with ectopic ureterocele in 9 Laparoscopic opera tion was recommended in children older than one year, minimally 10 kg, significant kidney dilatation, no reflux and preserved upper segment function We evaluated age of patients, operating time, success rate, follow up and complications Results: Median age was 29 (14–184) months, median operating time 210 (110–320) minutes In all patients decreased or vanished upper tract dilata tion Median follow up was 18 (5–120) months No reoperations were recorded The most frequent complication was urinary leak from anastomosis in 7 (20%) cases The reason was failure of urine diver sion in 5 children (2 nephrostomy failure, ureteral catheter dysfunction in 3), remaining 2 patients were operated without urine diversion Complica tions were resolved by ureteral catheter insertion in 3 and ureteral stent insertion in 4 cases Conclusion: Laparoscopic UPS represents al ternative mini‑invasive method in duplex kidney anomalies treatment It has high success rate and low rate of complications The most frequent prob lem is urine leak from anastomosis Therefore, the choice of reliable urine diversion is critical

Keywords:

Duplex kidney, megaureter, uretero‑pyelostomy, laparoscopy, children