Laparoscopic nephroureterectomy with fulgaration of the intravesical ureter in children with non-functioning refluxing kidneys

INTRODUCTION AND OBJECTIVES: We have experience with eight children ranging in age from 14 months to 15 years with non-functioning kidneys secondary to massive vesicoureteral reflux. Four of these children had recurring urinary tract infections. Six patients were female and two were male. One of the male children had urethral valves treated in the past. AIL children were followed for a minimum of six months to a maximum of four years. METHOD: The nephroureterectomy was performed from a retroperitoneal approach laparoscopically; the ureter was transected generally at the level of the iliac vessels. During the same anesthetic the children were cystoscoped and the intravesical ureter was scoped with a 9.2 F infant scope. The distal ureter was fulgarated with a bugby electrode including the orifice. RESULTS: This procedure was performed as an outpatient procedure in six chiIdren. One child was hospitalized for 24 hours. Another child was hospitalized for 48 hours (due to azotemia). The average operating time was 124 minutes. All children were able to return to full activity, including sports, within seven days of the procedure. Hypertension was cured in three patients and unchanged in one patient with only a six month follow-up. CONCLUSION: We conclude that this approach is safe in children with minimal morbidity and saves large incisions and associated morbidity as is seen with the open procedures.