[Analysis of results after primary heminephrectomy in surgical treatment of duplicated pyelo-caliceal system].

AIM

Determination of the effective diagnostics and therapeutic procedures in duplicated pyelo-calyceal system with upper pole dysfunction.

METHOD

Retrospective review of operative procedures and follow-up.

MATERIAL

In Department of Pediatric Surgery University of Medical Sciences in Poznań (Poland), 383 children with duplicated pyelo-calyceal system were treated between 1976 and 1997. The diagnosis was based on: IVP, MCU, scintigraphy, cystoscopy, and since 1984 on US. Conservative treatment was performed in 103 (26%) children with low VOR. The most frequent surgical procedure was Politano-Leadbetter ureteroneocystostomy carried out in 167 (44%) children. Primary heminephrectomy was performed in 79 (21%) patients with complete deterioration of the upper pole of the kidney. In order to attain upper pole parenchyma protection in 34 (9%) children the following primary procedures were performed: extirpation of the ureterocele with ureteroneocystostomy of both ureters, cutaneous uretral stoma or uretero-pyeloanastomosis.

RESULTS

Among 79 children with primary heminephrectomy of the duplicated system with ureterocele, secondary operation was required only in 18 patients. From 34 children with kidney parenchyma protecting procedures in 18 patients secondary heminephrectomy or nephrectomy was performed.

CONCLUSIONS

1. Primary heminephrectomy with ureterectomy with partial ureterectomy is a method of choice in the treatment of seriously deteriorated upper pole of the duplicated pyelo-calyceal system. 2. Secondary surgical procedures were required only in 25% of children in whom primary heminephrectomy was performed. 3. Primary heminephrectomy is a save procedure with a low complication rate.