Left upper pole nephrectomy by retroperitoneoscopy for the treatment of diurnal enuresis

This is the case of a 7-year-old girl presenting with diurnal incontinence for several years. She has been followed up for 3 years by a psychiatrist because of diurnal enuresis. Radiological findings showed a duplex kidney to the left with a dysplastic upper pole emptying into a megaureter with an ectopic ureteric insertion at vaginal level.

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Left upper pole nephrectomy by retroperitoneoscopy for the treatment of diurnal enuresis

Authors

Abstract

This is the case of a 7-year-old girl presenting with diurnal incontinence for several years. She has been followed up for 3 years by a psychiatrist because of diurnal enuresis. Radiological findings showed a duplex kidney to the left with a dysplastic upper pole emptying into a megaureter with an ectopic ureteric insertion at vaginal level.

Catégorie

basic techniques

Mots-clés

Left upper pole nephrectomy, retroperitoneoscopy, diurnal enuresis

Type de vidéo

Vidéo chirurgicale

Durée

03'25''

Publication

2008-11

Popularité

Favoris

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Audio

Sous-titres

E-publication

WeBSurg.com, Nov 2008;8(11).
URL: http://www.websurg.com/doi-vd01en2445.htm

Left upper pole nephrectomy by retroperitoneoscopy for the treatment of diurnal enuresis

1. Clinical case presentation and trocars 00'14''

A left upper pole nephrectomy with a retroperitoneoscopic approach is decided upon. The child is placed in a right lateral decubitus. Three trocars are used: one optical 10mm port and two 5mm operating ports. The retroperitoneal space is approached anterior to the distal extremity of the 12th rib. The retroperitoneal space is partially detached and freed thanks to the inflation of a handcrafted balloon. Once the optical is inserted into this space, 2 instruments are placed, the 1st one through an incision anterior to the anterior superior iliac spine and the 2nd one in the paravertebral space underneath the optic. The peritoneum is freed from the plane of the psoas muscle that can be seen at the bottom of the screen. The dissection is carried out and reaches the 2 ureters.

2. Ureter dissection 01'16''

The pathological megaureter draining the upper pole of the kidney and the small calibre healthy ureter that drains the middle and lower pole of the kidney. When the ureters are freed, caution must be paid not to devascularize the healthy ureter that is left in place. Monopolar cautery should not be overused during this dissection. The ureteral dissection leads to the lower pole of the kidney. The kidney is lifted cephalad and placed against the peritoneum.

3. Methylene blue dye test 01'52''

Dissection performed posterior to the kidney helps us to immediately free the vascular plane, with the artery anteriorly and the vein posteriorly. In the present case, only the vessels supplying the upper pole must be divided. From then onwards, the color of the parenchyma of the upper pole changes and turns blue, thereby allowing to clearly delimitate the division area, leaving the healthy middle and lower pole of the left kidney in place. The adrenal gland is left in place before the renal parenchyma is divided. The megaureter is emptied in order to sample urine for bacteriological examination.

4. Division of ureter 02'44''

The megaureter is opacified with diluted methylene blue, thereby allowing to clearly identify the ectopic ureteric insertion at vaginal level at the end of the procedure.

5. Extraction of specimen 02'54''

The ureter is then divided distally and as caudally as possible. The procedure ends with division of the parenchyma. The specimen is extracted through the 10mm optical port site. The child is discharged on postoperative day 1 once a renal Doppler ultrasonography has been performed to corroborate the vitality of the middle and lower pole of the left kidney left in place.