Piotr Gastoł, Małgorzata Baka-Ostrowska, Lidia Skobejko-Włodarska, Krystyna Strulak, Karina Felberg
- Klinika Urologii Dziecięcej, Instytut "Pomnik-Centrum Zdrowia Dziecka"
Kierownik kliniki: dr hab. Małgorzata Baka-Ostrowska
kidney, hydronephrosis, calycoureterostomy, child, horseshoe kidney, failed pyeloplasty
- There are certain anatomical conditions when the access to the renal pelvis is impossible, as in a small intrarenal pelvis or massive peripelvic fibrosis or scaring. In above situation one should consider calycoureterostomy.
- the aim of the study
- The aim of the paper is the presentation our experience with this procedure in 8 children.
- materials and method
- Between 1999-2003, 8 boys in age from 1.5 year to 15 years (mean 8.5 years) underwent calycoureterostomy. In 5 patients it was a primary procedure, in 3 secondary after failed pyeloplasty. There was one horseshoe kidney. Through flank incision the parenchyma of the lower kidney's pole was excised, and ureter was anastomosed with lower calyx. Every anastomosis was splinted.
- There was no early post-operative complication observed. Long-term success (good drainage and decompression of dilatated system) was achieved in 7 children. In one patient a bad effect was due to obstructed anastomosis by a thick parenchyma of the lower pole, what was found during reoperation. After excision of a significant wedge of tissue, reanastomosis was performed. One year later good drainage is observed. All operated kidneys present good function, and there was no need of nephrectomy.
- Calycoureterostomy should be the procedure of choice in cases when dependent drainage cannot be obtained by pyeloplasty. Massive caliceal dilatation with small pelvis, large hydronephrosis in horseshoe kidney is the best example. We stress the need for large parenchymal excision in the area of anastomosis.
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