Indications for Nephrectomy in children: What has changed?

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Published Apr 3, 2010
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Vol. 88 No. 4 (2010): Issue Apr 2010

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Faouzi Nouira
Nadia Sarrai
soufiane Ghorbel
Yakoub Ould Med Sghair
Rachid Khemakhem
Awatef Chariag
Said Jlidi
Beji Chaouachi

Abstract

Background: The last decade has witnessed significant refinements in preoperative diagnostic evaluation and an improvement in surgical techniques and postoperative management for paediatric patients. There has been an improvement in our understanding of the natural history of some congenital renal anomalies which has caused some changes in management approach.
Aim : To review the indications for nephrectomy in children between 1996 and 2008, at the departement of paediatric surgery, children’s hospital in Tunis.
Methods: There were 80 nephrectomies. A retrospective review of the patients’ notes was performed. The 13-year period was divided into two halves (1996-2000 and 2001-2008) which were then compared.
Results: The total number of nephrectomies per year significantly increased over the period of the study (4,6 and 8 nephrectomies per year for 1996-2000 and 2001-2008, respectively ; P< 0.05), as did the number of nephrectomies for Multicystic dysplastic kidney (MCDK) (zero and 5 for 1996-2000 and 2001-2008, respectively) and wilms’tumour (8,3% and 29,16% for 1996 - 2000 and 2001 - 2008, respectively).Wilms’ tumour, vesico-ureteric reflux (VUR) and pelvi-ureteric junction (PUJ) obstruction accounted for more than half of the nephrectomies (80% and 58% for 1996-2000 and 2001- 2008, respectively). The proportion of nephrectomies performed for VUR did not change (15% and 12% for 1996-2000 and 2001-2008, respectively) but fewer nephrectomies were performed for pelviureteric junction (PUJ) obstruction in the second half of the study period (44% and 4,16% for 1996-2000 and 2001-2008, respectively ; P <0.05).
Conclusion: The total number of nephrectomies, including partial nephrectomies, has increased significantly. The decrease in nephrectomies for PUJ obstruction could be accounted for by a more aggressive approach in the management and follow up of prenatally diagnosed hydronephrosis. Of note is that there was no significant change in the proportion of nephrectomies performed for VUR. On the contrary, the proportion of nephrectomies increased for neoplastic lesions and MCDK.

Keywords:

Nephrectomy, Indications, Children

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References

  1. Figenshau RS, Yu MK. Laparoscopic nephrectomy and nephroureterectomy in the pediatric patient. Urol Clin North Am 2001;28:53-60.
  2. Shanberg AM, Sanderson K, Rajpoot D, et al. Laparoscopic retroperitoneal renal and adrenal surgery in children. BJU Int 2001;87:521-4.
  3. Scott Jr RF, Selzman HM. Complications of nephrectomy: review of 450 patients and a description of a modification of the transperitoneal approach. J Urol 1966;95:307-12.
  4. Beisland C, Medby PC, Sander S, et al. Nephrectomy - indications, complications and postoperative mortality in 646 consecutive patients. Eur Urol 2000;37: 58-64.
  5. Schmidt A, Dietz HG, Schneider K. Long-term results after partial and unilateral nephrectomy in childhood. Eur J Pediatr Surg 1992;2:269-73.
  6. Pearlman CK, Kobashigawa L. Nephrectomy: review of 200 cases. Am Surg 1968;34:438-41.
  7. Sairam S, Al-Habib A, Sasson Sand al. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 2001;17:191-6.
  8. P. Buisson, J. Ricard, B. Boudailliez, and al. Évolution de la prise en charge du syndrome de la jonction pyélo-urétérale Change in management of ureteropelvic junction obstruction : Archives de pédiatrie 2003;10:215-20.
  9. Capolicchio G, Leonard MP,Wong C, Jednak R, Brzezinski A, Salle JL. Prenatal diagnosis of hydronephrosis: impact on renal function and its recovery after pyeloplasty. J Urol 1999;162:1029-32.
  10. Hodson C, Edwards DW. Chronic pyelonephritis and vesicoureteric reflux. Clin Radiol 1960;11:219-31.
  11. Craig JC, Irwig LM, Knight JF, et al. Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 2000;105:1236-41.
  12. Wacksman J, Phipps L. Report of the Multicystic Kidney Registry: preliminary findings. J Urol 1993;150:1870-2.
  13. John U, Rudnik-Schonebom S, Zerres K, et al. Kidney growth and renal function in unilateral multicystic dysplastic kidney disease. Pediatr Nephrol 1998;12:567-71.
  14. Atiyeh B, Husmann D, Baum M. Contralateral renal abnormalities in patients with renal agenesis and noncystic renal dysplasia. Pediatrics 1993;91:812-5.
  15. Gordon AC, Thomas DF, Arthur RJ, et al. Multicystic dysplastic kidney: is nephrectomy still appropriate? J Urol Nov 1988;140(5 Pt 2):1231-4.
  16. Webb NJ, Lewis MA, Bruce J, et al. Unilateral multicystic dysplastic kidney: the case for nephrectomy [see comment]. Arch Dis Child Jan 1997;76 :31-4.
  17. Perez LM, Naidu SI, Joseph DB. Outcome and cost analysis of operative versus nonoperative management of neonatal multicystic dysplastic kidneys. J Urol 1998;160:1207-11.
  18. J. Bacchetta1, A. Liutkus1, H. Dodat2, et al ; Multicystic dysplastic kidney disease: Update and information for parents at the time of prenatal diagnosis ; Archives de Pédiatrie 2008;15:1107-1115
  19. Privett JT, Jeans WD, Roylance J. The incidence and importance of renal duplication.ClinRadiol 1976;27:521-30.
  20. Linni K, Urban C, Lackner H, Hollwarth ME. Nephronsparing procedures in 11 patients with Wilms' tumor. Pediatr Surg Int 2003;19:457-62.
  21. Haecker FM, von Schweinitz D,Harms D, Buerger D,GrafN. Partial nephrectomy for unilateral Wilms tumor: results of study SIOP 93-01/GPOH. J Urol 2003;170:939-42.