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

2. 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

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

4. 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

5. General Considerations
Abdominal Mass in a newborn child

6. General Considerations
Abdominal Mass in a newborn child

7. 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 ?

8. Setting
Cortical thinning

9. Setting
Cortical thinning

10. Setting
Cortical thinning

11. Setting
UPJ imaging

12. Setting
UPJ Imaging

13. Setting
UPJ Imaging : CAVE !

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

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

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

17. Setting
Minimally Invasive

18. Pyeloplasty

19. Setting
Trocar placement: only three arms

20. Setting
Docking

21. Setting
Trocar placement: only three arms

22. 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

23. 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

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