IS CONTRALATERAL EXPLORATION OF THE KIDNEY NECESSARY IN PATIENTS WITHWILMS-TUMOR

Purpose: Surgical exploration of the contralateral kidney in patients with Wilms tumor is standard practice. The introduction of modern imag ing techniques (ultrasound, computerized tomography and magnetic reson ance imaging) in place of excretory urography has led to a more accura te definition of intrarenal pathology. Is contralateral kidney explora tion still necessary in patients with Wilms tumor? Materials and Metho ds: We reviewed the records of 75 patients from 3 medical centers who were evaluated and treated for Wilms tumor in the last 14 years. All c hildren underwent preoperative excretory urography, computerized tomog raphy, ultrasound and/or magnetic resonance imaging. Results: Seven bi lateral Wilms tumors were diagnosed preoperatively and confirmed surgi cally, whereas extensive operative exploration of the contralateral ki dney in the other 69 patients revealed no additional pathological cond ition. This concurred with preoperative radiological findings with 100 % sensitivity and specificity. Furthermore, 1 month to 12 years of fol lowup (mean 4.3 years) revealed no tumor in the contralateral kidney. The major postoperative complication was small bowel obstruction in 5 patients 15 to 180 days (mean 77.2) after explorative laparotomy. Conc lusions: In all patients preoperative radiological investigation was a ccurate in excluding bilaterality. With modern imaging techniques and effective chemotherapy extensive contralateral renal exploration may n o longer be mandatory for managing Wilms tumor.