Postoperative complications in congenital hydronephrosis through laparoscopic approach in children. Clinical case presentation

Abstract

Introduction. Congenital hydronephrosis due to obstruction of the pyeloureteral segment remains one of the most common malformative uropathies. The effectiveness of interventions in the plasty of the pyeloureteral junction by video-assisted laparoscopic approach - up to 96% in case of primary stenosis, versus traditional surgical technique - pyeloureteroanastomosis by Anderson-Hynes with 90% efficacy. Case presentation. Patient B., in 2014 was diagnosed with hydronephrosis of the right kidney gr. III-IV, preoperative pelvis was 39 mm and calyxes – 17 mm. On April 10, 2014, he underwent laparoscopic right pyeloplasty (in the Russian Federation). Postoperatively, on ultrasound examination, the pelvis of the right kidney contracted up to 8 mm, and after a year it dilated up to – 30 mm. Evolutionary ultrasound examination of the urinary system revealed - renal pelvis of the right kidney – 35 mm. and in the lower calyx the calculus 6-7 mm. On dynamic renal scintigraphy, the right kidney is increased in size, the distribution of the radiopharmaceutical is non-uniform, and the function of filtration and secretion of urine is significantly reduced - according to the obstructive type. In the child, an abnormality of congenital development of the urinary system is determined: hydronephrosis gr. III-IV on the right, complicated with kidney stones and chronic pyelonephritis. Nephroptosis gr. I on the right side. Discussion. Surgical reintervention was performed by „open” approach – lumbotomy on the right – the obliteration of the ureter was found throughout and an advanced adhesion process of keloid type, therefore nephroureterectomy was performed. Conclusion. By presenting this case we can conclude that in the plasty of the pyelo-ureteral segment by video-assisted laparoscopic approach, complications such as ureter damage and active hemorrhages that are difficult to stop, the formation of an advanced adhesion process can occur.