Child with kidney swelling diagnosed as PUJ obstruction and managed with laparoscopic pyeloplasty
Case 2: Child with kidney swelling diagnosed as PUJ obstruction and managed with laparoscopic pyeloplasty
2-year male child was brought to the pediatric urology clinic at MITR hospital, Kharghar, Navi Mumbai for an opinion for left kidney swelling. This kidney swelling was diagnosed by ultrasound done during pregnancy and they have been on regular follow up after the birth of the child. Ultrasound was done 3 monthly, and the swelling was on an increasing trend. One ultrasound showed left kidney pelvis diameter to be of ~44mm with thinning of the renal parenchyma which was significant. EC scan (nuclear renal scan) was done to find out about the drainage of the left kidney and percentage function. The EC scan showed significant obstruction at the left pelviureteric junction with preserved kidney function. Since the swelling was significant and there was obstructed drainage, he was planned for laparoscopic kidney surgery to relieve the block, pyeloplasty.
Pic 1: Pre surgery USG showed significant swelling of the left renal pelvis (APD 44mm)
Pic 2: Pre surgery EC scan showed significant retention of tracer with obstructed drainage in the left kidney
Laparoscopic pyeloplasty was performed successfully. During the surgery, we found that the ureter was obstructed and narrow at the pelviureteric junction, which was removed, and normal calibre ureter was sutured to the pelvis over a double J stent to make a wider passage, restoring normal urine flow. Laparoscopic pyeloplasty was performed successfully and child recovered uneventfully. A double J stent which was placed across the anastomosis and was removed by cystoscopy after 6 weeks.
Ultrasound done 1 month after the DJ stent removal showed significant decrease in the kidney swelling i.e. 12mm with improvement in parenchymal thickness. EC scan in the post-surgery period showed good non obstructed drainage.
Pic 3: Post surgery ultrasound showed significant reduction in the left pelvis diameter(12mm) from 44mm in the pre surgery period
Pic 4: Post surgery EC scan showing good clearance of the tracer and non-obstructed drainage
Laparoscopic pyeloplasty in children
Laparoscopic pyeloplasty is a minimally invasive surgical procedure used to treat the condition pelviureteric junction obstruction (PUJO). Laparoscopic surgery in children has been possible due to presence of smaller telescope, miniaturized equipment and presence of experienced laparoscopic surgeons. Laparoscopy in children is associated with smaller scars, lesser pain in the post-surgery period and early recovery.
In laparoscopy, a small 5mm hole is made in the belly button or navel and a telescope is inserted through this. Carbon di oxide is infused inside the abdomen at an acceptable pressure with constant flow of this carbon di oxide which inflates the belly and gives working space for the surgeon. Two more small holes of 3mm and 5mm are made in the upper and lower abdomen and small instruments are inserted through these holes. The entire surgery is done by inserting long instruments through these small holes.
The success rate of laparoscopic pyeloplasty at our centre MITR hospital is more than 98%. The benefits of laparoscopic pyeloplasty are smaller incisions with lesser scarring, less post operative pain and quicker return to normal activities.
Pediatric Urology centre at MITR hospital, Kharghar, Navi Mumbai offers best treatment for kidney swelling due to PUJ obstruction in children. Pediatric urology centre at MITR hospital is managed by Dr A.K. Singal and Dr Ashwitha Shenoy, who are considered one of the best pediatric urologists with expertise in managing kidney swellings in children. At MITR hospital, every child is evaluated thoroughly, and surgery is recommended only if necessary.
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