Lap techniques show excellent results in children

When Howard M. Snyder, MD, was asked to moderate a session on the latest developments in pediatric urology at the American College of Surgeons clinical congress last fall, he didn't have to think twice about the topics he wanted to cover.

They also appear to be the areas in which the most thought-provoking pediatric research will be presented at the AUA meeting, particularly laparoscopic surgery.

Nephrectomy, renal transplant, retroperitoneal lymph node dissection, and pyeloplasty are all being performed laparoscopically in children with increasing regularity.

A group of researchers will report their experience with six children who underwent laparoscopic nephrectomy following preoperative chemotherapy for unilateral, nonmetastatic Wilms' tumor. There were no conversions in the group, the postoperative period was painless and uneventful, and patients were discharged on the second or third postoperative day.

Robotic assistance is also proving helpful in laparoscopic urologic surgery, as evidenced by positive data to be presented on robotically assisted laparoscopic pyeloplasty and anti-reflux surgery, Dr. Snyder said.

Dextranomer/hyaluronic acid copolymer (Deflux) is receiving increasing attention as a treatment for vesicoureteral reflux. Investigators examining success rates after second injections of the gel in patients for whom initial treatments fail found second injections to be a reasonable therapeutic option "with an acceptably high success rate." That information, they say, will be helpful in counseling parents after first-injection failures.

In another study, dextranomer/hyaluronic acid copolymer was found to be cost-effective as a substitute for ureteral reimplantation for management of VUR.

"It has an economic and a practical advantage," Dr. Snyder said. "It gets kids off of antibiotics, which is obviously a desirable outcome."

Among the advances being presented is in the area of tissue engineering. Researchers have found that adipose-derived stem cells injected into the bladder and urethra can differentiate into smooth muscle in vivo. Thus, they could serve as an easily accessible and viable source of tissue for urologic reconstruction and regeneration.

"This is an intriguing paper with a pretty extraordinary finding," said Dr. Snyder. "It's likely to be one of the most important papers we have in the pediatric section this year."

Other advances AUA attendees may want to take note of other pediatric urology research being presented in San Antonio, Dr. Snyder said, including the following: