Feasibility of Laparoscopic Nephrectomy in Children With Hydronephrotic Kidneys: A Prospective Study

Background Laparoscopic nephrectomy has become gradually popular in pediatric cases related to urology because of its minimally invasive nature and favorable outcomes. However, its feasibility in hydronephrotic, non-functioning kidneys remains a technical challenge in children due to anatomical distortion and potential adhesions. Objective The main objective of this study is to assess the feasibility, safety, and outcomes of transperitoneal laparoscopic nephrectomy in children with hydronephrotic kidneys. Methods The prospective observational research was carried out at The Kidney Centre Postgraduate Training Institute, Karachi, Pakistan, from May 2019 to August 2023. A total of 102 pediatric patients with non-functioning hydronephrotic kidneys underwent laparoscopic nephrectomy. Demographic, intraoperative, and postoperative parameters were recorded. The statistical study included descriptive statistics and the Chi-square test for associations. Results The median age was seven years, with 62 males (60.8%) and 40 females (39.2%). The left kidney was more commonly affected (57, 55.9%). Pelviureteric junction obstruction (PUJO) was the most frequent etiology (46, 45.1%), followed by stone disease (39, 38.2%) and vesicoureteral reflux (VUR) (17, 16.7%). Laparoscopic nephrectomy was completed in 96 patients (94.1%), with six (5.9%) conversions to open surgery. The mean operative time was 93.5 ± 18.7 minutes, and the mean blood loss was 72.4 ± 25.6 mL. Intraoperative complications occurred in five patients (4.9%), and postoperative complications in seven (6.9%) - all low-grade. Conversion was significantly associated with PUJO (p = 0.034), longer operative duration (p = 0.001), and more blood loss (p = 0.004). No significant associations were found with gender or kidney side. Conclusion The findings of the research show that transperitoneal laparoscopic nephrectomy is a feasible and safe option in children with hydronephrotic kidneys, demonstrating low complication and conversion rates when performed by experienced surgeons.