Single-stage laparoscopic pyeloplasty and nephropexy in a 14-year-old child

Introduction. Hydronephrosis in children is a well-studied disease in terms of etiopathogenesis, examination methodology and surgical methods. In the practice of a pediatric urologist-andrologist, it is challenging to exclude multifactorial pathological processes that are caused by multi etiologies. In such cases, the diagnostic algorithm can be expanded, and the tactics of surgical treatment changes depending on the new data obtained. The purpose of the report is to demonstrate the algorithm of diagnostic approaches with diagnosis verification and subsequent successful one-stage combined surgical treatment of patient with hydronephrosis on the right, caused by an aberrant vessel in combination with nephroptosis.

Materials and methods. On the basis of clinical observation, the case history of a 14-year-old girl with a combined pathology — nephroptosis and hydronephrosis on the left, caused by an additional lower polar vessel, is presented. For two years, clinical manifestations of the disease were recurrent headaches and pain in the lumbar region on the left, for pain relief the patient regularly took non-steroidal anti-inflammatory drugs (NSAIDs). Despite, the typical results of the instrumental examination for hydronephrosis, the algorithm was expanded, due to the peculiarities of the clinical picture, which included headaches, lower back pain, and episodes of increased blood pressure. As a result of additional examination, a combined pathology was detected — nephroptosis on the left. Based on the results, the child underwent one-stage laparoscopic antevasal pyeloplasty with nephropexy. The result of the surgical treatment was the relief of pain syndrome — the complaints of headaches and pain in the lumbar region disappeared, normalization of blood pressure figures, restoration of urodynamics, by the results of instrumental investigations it was confirmed a reduction in the size of the renal collecting system and a decrease in its mobility during orthostatic testing. Conclusions. One-stage laparoscopic nephropexy and isolating pyeloplasty can be considered the operation of choice for nephroptosis combined with an additional lower polar renal vessel. If the algorithm for performing this surgical treatment and postoperative management is followed, a satisfactory result is most likely achieved.

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