Laparoscopic repair of congenital midureteric strictures in infants and children.

PURPOSE

Congenital midureteric strictures (CMUS) are an uncommon cause of obstructive uropathy. There are only a few case reports of laparoscopic management of CMUS. We present our experience with laparoscopic repair of CMUS in 7 children.

PATIENTS AND METHODS

The records of all children (n=7, 5 infants) undergoing laparoscopic reconstruction for CMUS were reviewed. Preoperative imaging included ultrasound (US) and diuretic renography (DR) in all children. Intravenous urography or magnetic resonance urography was performed in 3 children when a dilated ureter was seen on the ultrasound. Retrograde pyelography was performed in 6 children before definitive surgery. All children underwent transperitoneal laparoscopic excision of the stricture with ureteroureterostomy. Follow-up included clinical examination and US in all children, with DR in 5 children.

RESULTS

Over a 3-year period, 7 children underwent laparoscopic repair of CMUS. Six children had antenatally diagnosed hydronephrosis, while one child presented with infected hydronephrosis, underwent nephrostomy and was later referred to us. The diagnosis of CMUS was suspected preoperatively in 4 children; in 3 children, diagnosis of CMUS was confirmed on retrograde pyelography. Laparoscopic repair was successfully completed in all children; there were no significant intraoperative or postoperative complications. At a median follow-up of 18months, all children are asymptomatic, with US (7) and DR (5) confirming significant reduction in the hydronephrosis and improved drainage. The cosmetic results have been excellent.

CONCLUSION

To our knowledge, this is the first report of laparoscopic repair of CMUS in children. Laparoscopic repair of CMUS can be safely and successfully performed even in small infants, with good results.