Simultaneous Bilateral Pediatric Nephrectomies: Indications, Approach and Outcomes Over a 15-Year Period.

Abstract

Background: Reports on bilateral simultaneous native nephrectomies in the pediatric population are lacking. This study evaluates indications and outcomes of a tertiary care pediatric hospital's single center experience with bilateral simultaneous native nephrectomies over 15 years.

Methods: A retrospective chart review of pediatric patients (< 21 years old) who underwent bilateral simultaneous native nephrectomy from January 1, 2009, to August 1, 2024, at a single institution was performed for surgical indications, approach, and outcomes.

Results: Ten patients were identified. Mean age at bilateral simultaneous nephrectomy was 9.6 years (range 14 months-19 years). Surgical indications included hypertensive crisis in four, nephrotic syndrome in three, Polycythemia Vera in one, recurrent urinary tract infections (UTI) in one, and significant hydroureteronephrosis in one patients. Prior to nephrectomy, six patients were on hemodialysis, two patients were on peritoneal dialysis (PD), and two patients were not on any form of dialysis. Of the 10 patients, four underwent surgery during an inpatient admission for an acute exacerbation of the listed indication. Three cases were done robotically (transperitoneal), and seven were performed open. Both patients on PD preoperatively underwent open retroperitoneal surgery and were able to restart PD on postoperative day 1. There was one complication in a patient with recurrent UTIs who developed an intra-abdominal abscess, requiring percutaneous drainage.

Conclusions: Bilateral simultaneous native nephrectomy is a safe and effective way to manage conditions associated with end-stage renal disease in pediatric patients. In our experience, this can be done by an open or minimally invasive approach.