Page 12 - CUA 2020_Pediatric

2020 CUA ABSTRACTS

Moderated Poster Session 12: Pediatric Urology

MP-12.1 MP-12.2
Back (door) to the future: Dorsal lumbotomy for pediatric upper Native nephrectomy prior to kidney transplant: A 16-year
pole heminephrectomy institutional experience
2
1,2
1
Aishwarya Roshan , Andrew E. MacNeily 1,2,3 Jin Kyu Kim , Lucshman Raveendran , Michael E Chua , Armando J.
2
1,2
3
4
1 Faculty of Medicine, University of British Columbia, Vancouver, BC, Lorenzo , Walid A. Farhat , Jessica M Ming , Martin A. Koyle 1,2
Canada; Department of Urologic Sciences, University of British Columbia, 1 Division of Urology, Department of Surgery, University of Toronto, Toronto,
2
Vancouver, BC, Canada; Division of Pediatric Urology, BC Children’s ON, Canada; Division of Urology, Department of Surgery, Hospital for
3
2
3
Hospital, Vancouver, BC, Canada Sick Children, Toronto, ON, Canada; Surgery, University of New Mexico,
4
Introduction: The dorsal lumbotomy approach to renal surgery has become Albuquerque, NM, United States; Urology, University of Wisconsin,
a lost art. Upper pole heminephrectomy (UHN) is performed for two main Madison, WI, United States
indications: ectopic ureterocele and duplication anomalies with upper pole Introduction: The associated risks of pre-transplant native nephrectomies in
ectopy. Current popular techniques for conducting UHN include open pediatric renal transplant patients remain unclear. This investigation aims
flank, laparoscopic, and robotic. This study evaluates outcomes following to assess the clinical outcomes for pediatric renal transplant patients who
dorsal lumbotomy (DL), an approach used historically for pyeloplasty and underwent pre-transplant native nephrectomy.
pyelolithotomy, and in which no clinical trials or case-series have been Methods: A retrospective review of renal transplants performed at our insti-
conducted for UHN in children. 1,2 tution from 2000–2015 was performed. Transplant recipients were divided
Methods: We conducted a retrospective review of 50 UHN performed in 49 into those who underwent native nephrectomy and those who did not.
patients using the DL approach by a single surgeon from 2000–2019. Clinical Clinical outcomes (estimated glomerular filtration rate [eGFR], Clavien-
variables and indicators included age, sex, weight, skin-to-skin time, total Dindo classification ≥3 complications, graft loss, and number of readmis-
operating room time, duration of hospital stay, postoperative complications, sions) were compared. Subgroup analyses were performed for unilateral/
analgesic requirements, and postoperative ultrasound results. concurrent bilateral/staged bilateral nephrectomies.
Results: Twenty-three cases had a presurgical diagnosis of ectopic ure- Results: A total of 324 patients were identified. Fifty-seven patients under-
ter, and 27 ureterocele. Mean weight (range) of patients was 12.61 kg went native nephrectomy (18 unilateral, 27 concurrent bilateral, 12 staged
(6.90–31.00), and mean age at surgery was 24.55 months. Mean (range) bilateral). The nephrectomy group was more likely to be younger, receiv-
for time between skin incision and closure was 88.51 (62–132) minutes ing living donor kidneys, and to have ≥2 donor kidney arteries (Table
and mean (range) total operating room time was 138.46 (70–180) min- 1),while also having more patients with nephrotic syndrome, nephritis, and
utes. There were neither intraoperative complications nor transfusions. The focal sclerosing glomerulosclerosis (p=0.002) (Fig. 1). Most nephrectomy
mean (range) postoperative opioid delivered was 0.73 (0.00–2.00) mg/kg/ indications were hypertension (42.7%) and proteinuria (28.1%) (Fig. 2).
day. Mean (range) postoperative ibuprofen delivered was 5.41 (0.00–37.73) In multivariate analyses (controlling for significant baseline characteris-
mg/kg/day. Median length of hospital stay was two days. No patient received tics and nephrectomy specific factors — laparoscopic, nephrectomy at
postoperative prescriptions for narcotics at discharge. No patient experi- time of transplant, nephrectomy prior to transplant, previous transplant
enced wound complications. One patient had secondary atrophy of the nephrectomy), native nephrectomy (ß 1.138; 95% confidence interval [CI]
lower pole. Secondary lower tract surgery, unrelated to surgical approach, 0.137–2.138; p=0.026) and bilateral nephrectomy (ß 2.733; 95%CI 1.313–
was performed in six patients. 4.152; p<0.001) were associated with higher readmission rates. Patients
Conclusions: DL is a historical approach for UHN that should not be forgot- with nephrectomies were more likely to be readmitted with bacterial infec-
ten. It is safe, feasible, and produces operative outcomes and times compa- tions (29.8% vs. 15.4%; p=0.013) (Fig. 3).
rable or superior to that of conventional open flank incision, laparoscopic,
and robotic techniques.
References 60%
1. Bajpai M, Kumar A, Tripathi M, et al. Dorsal lumbotomy incision 50%
in pediatric pyeloplasty. ANZ J Surg 2004;74:491-4. https://doi. 40%
org/10.1111/j.1445-1433.2004.03032.x % of patients 30%
2. Verma A, Bajpai M, Baidya DK. Lumbotomy approach for upper uri-
nary tract surgeries in adolescents: Feasibility and challenges. J Pediatr 20%
Urol 2014;10:1122-5. https://doi.org/10.1016/j.jpurol.2014.05.001 10%
0%
Glomerulonephritis
CAKUT FSGS Nephritis Nephrotic Other
End-stage renal disease etiology
No nephrectomy (n=267) Nephrectomy (n=57)
MP-12.2. Fig. 1. Comparison of end-stage renal disease etiology between two
groups.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S149
© 2020 Canadian Urological Association