MIMS is the gold standard for heminephrectomy in duplex systems (DS). In our unit we perform retroperitoneal partial nephrectomy (RLPN). We describe our 10 year experience of RLPN, with minimum 2.5 years follow up.
Patients and Methods
We performed a single centre retrospective review of patients undergoing RPLN between 2005 to 2015. Indications for heminephrectomy were symptomatic, poorly functioning moiety in DS. Primary outcomes were intraoperative and cumulative complications, ie compound early, late and further surgery indicated (FSI). Chi2 analysis was used to test outcomes by presence of ureterocele.
We identified 54 RLPNs (43 females, 11 males), median follow up 6 years (2.5-11.3). Median age 3 years (range 10 months to 13 years) and weight 19.8kg (range 8-62kg). Mean operating time was 161 minutes and median LOS 2 days, 41% with less than 24 hour discharge.
Intraoperative complication rate was 1/51, due to peritoneal breach. Early complications included: 1 each for urinary retention, peri-renal leak, ileus and wound infection. Late complications included: 6 residual stump reflux, 5 requiring completion stumpectomy; 2 loss of kidney (1 each for disease progression and surgical technique) and 1 open excision ureterocele.
Mean length of ureter excised was 58.6mm (+/- 43.8). Presence of ureterocele (21 /51 cases) did not demonstrate significant association with complications (p=0.41).
Our intraoperative complication rates (1.9%), duration of procedure, and length of stay are all favourable against published literature, with no conversions. Our overall cumulative complication rate was 26%. We did not find any association between ureterocele presence and complications.