Pediatric Pyeloplasty : tips and tricks Anne-Françoise Spinoit Department of Urology, University Hospital Ghent, Belgium

Pediatric Pyeloplasty: General considerations Not every hydronefrosis in a child needs to be operated Hydronefrosis in a child DOES NOT EQUAL UPJ obstruction Only SYMPTOMATIC UPJ need to operated

General considerations UPJ ? - crossing vessels - intrinsic stenosis Hydronefrosis ? - 7% neonatal - 64 % UPJ stenosis

General Considerations Diagnosis: Anamnsestic ! Young children: Abdominal mass Hematuria Older children : Flank pain, renal colic Vomiting UTI Ultrasound: parenchymal thinning? MAG 3: Obstructive curve ? Retrograde pyelography

General Considerations Abdominal Mass in a newborn child

General Considerations Abdominal Mass in a newborn child

Setting Abdominal mass in a newborn Abdominal mass in child is historic presentation Prenatal hydronefrosis is a normal phase of development Most prenatally detected hydronefrosis are ASYMPTOMATIC Question: is it clinically relevant ?

Setting Cortical thinning

Setting Cortical thinning

Setting Cortical thinning

Setting UPJ imaging

Setting UPJ Imaging

Setting UPJ Imaging : CAVE !

Setting Indications for Surgery Pain with obstruction Impairment of overall function Impairment of ipsilateral function Stone or infection Hypertension

Setting Surgery Open ? Lumbotomy Minimally invasive ? Trans-peritoneal Retroperitoneoscopic Endopyelotomy ???

Setting Lumbotomy With advent of MIS, less frequent - Typically in children <1Y old - <10 kgs Typically Anderson-Hynes dismembered Pyeloplasty

Setting Minimally Invasive

Pyeloplasty

Setting Trocar placement: only three arms

Setting Docking

Setting Trocar placement: only three arms

Setting Pyeloplasty: Index case Is one of the few procedures where RA, until now, has proven superiority over lap Good knowledge about steps is essential Reconstructive part made easier compared to Lap

Setting Conclusions Completely different compared to adults ! Do not operate when unnecessary ! Know what you’re good at: Laparascopy? Open ? Robot? … or know when to refer to someone else

Robotics in children Anne-Françoise Spinoit Department of Urology, University Hospital Ghent, Belgium