WOFAPS 2025 8th World Congress of Pediatric Surgery

Vasily Shumikhin ¹, Marina Shumikhina ¹, Marina Levitskaya ¹, Nadezhda Erokhina ¹, Maria Boguslavskaya ²

¹ Pirogov Russian National Research Medical University, Moscow, Russia
² Russian Medical Academy of Continuing Professional Education

Male infant 2,5 month years old was presented with 8 hours of anuria. Prenatal ultrasound showed nothing. Soon after birth bilateral pyelectasia was founded. On the ultrasound examination two days before anuria, bilateral hydronephrosis of horseshoe kidney was noted. During examination we found growing of kidney dimensions (plus 1 cm), collection of paranephral fluid, absance of urine in the bladder and high grade of serum potassium up to 7,5 mmol/l, creatinine 236 mcmol/l and urea 17 mmol/l. We performed emergent cystoscopy with transurethral intubation of both kidney pelvis by 3F and 4F catheters and got a quick resolve of AKI in 12 hours. Ten days later we have change intubators on J-J stents and have made diagnostic laparoscopy of right part of kidney. We found paranephral edema, compression of pyelo-ureteric junction (PUJ) by main renal vessels and stenosis of urether in the same place, after mobilization and dislocation of pelvis we performed laparoscopic dismembered pyeloplasty with anastomosis 1 cm distal to the vessels. Patient was discharged on the 3rd day after operation. One month later we have take out the J-J stent from right side and perform the laparoscopic dismembered pyeloplasty on the left side, where we found the compression of PUJ by main renal vessels, stenosis of urether and a severe scarring process around the left pelvis. Continious examinations after removingg of J-J stent shows normal ultrasound parmetres of the kidney and normal value of serum potassum, creatinine and urea.

Conclusion: Caution is needed in case of bilateral hydronephrosis of the horseshoe kidney in terms of a possible total kidney block, which may manifest as a clinic of anuria with the development of AKI. The choice of surgical procedure for vascular compression of the PUJ should be carried out depending on the clinical situation.