PATTERN OF PAEDIATRIC NEPHRECTOMIES IN A DEVELOPING NATION

PAEDIATRIC NEPHRECTOMIES

Abstract

Introduction: Nephrectomies are performed for indications that vary with age group and geographical locations. There is a trend towards the minimally invasive technique, but nephrectomy is still largely by open approach in the developing nations. Our objective is to evaluate the pattern of paediatric nephrectomies carried out in the Paediatric Surgery Unit of the Lagos State University Teaching Hospital over an eight-year period.

Methodology: A retrospective review of paediatric nephrectomies performed over eight years was carried out by collating the patients’ demographics, indication for nephrectomy, radiological investigation done, surgical approach, side and type of nephrectomy, duration of surgery, and peri-operative mortality. Data entry and analysis was done using Statistical Product and Service Solutions (SPSS) version 25.0 for windows and p-value of <0.05 was considered significant. 

Results: Seventy-five patients had nephrectomies during the study period comprising of 43 males and 32 females (M:F=1:0.74) with a median age of three years (IQR 1.7 – 5.5). The lesions were on the left in 46 (61.3%) patients, right in 28 (37.3%) patients, and bilateral in one (1.3%) patient. These amounted to 76 nephrectomies which were 76.3% radical, 21.1% simple and 2.6% partial nephrectomies with an average of nine nephrectomies per year. Fifty-seven (76%) of the patients had nephroblastoma while 14 (18.7%) had non-functioning kidneys from previously undetected pelvi-ureteric junction obstruction (PUJO). The radiological investigations for diagnosis were abdominal ultrasound scan (97%) contrast-enhanced computerized tomography scan of the abdomen (65%) and intravenous urography (37%). All cases were open surgeries via the anterior approach. There were four (5.3%) perioperative mortalities.

Conclusion: Nephroblastoma is the most common indication for nephrectomy in our centre while undetected PUJO is the most common non-malignant indication for nephrectomy. Early detection, surveillance, and timely intervention for PUJO would reduce need for nephrectomies in its treatment.