Laparoscopy as the investigation and treatment of choice for urinary incontinence caused by small 'invisible' dysplastic kidneys with infrasphincteric ureteric ectopia

Objective To report our experience of using laparoscopy for the accurate lo cation and simultaneous removal of small dysplastic kidneys with ectopic ur eteric insertion causing urinary incontinence and that were not detected by conventional imaging modalities. Patients and methods Seven girls (mean age 7.9 years, range 3.5-13) present ed with urinary leakage occurring between normal voids. Imaging studies inc luding ultrasonography, renal scintigraphy, intravenous urography, computed tomography and/or magnetic resonance imaging in six of the seven patients revealed a single normal functioning kidney,but failed to detect the contra lateral nonfunctioning dysplastic kidney. All patients were examined under anaesthesia, followed by transperitoneal laparoscopy for the simultaneous l ocalization and removal of the dysplastic kidneys under the same setting. Results Laparoscopy in all seven patients revealed a small dysplastic kidne y that could always be easily located by first finding the draining ureter over the iliac vessels and then following it upwards. Four dysplastic kidne ys were found in the renal fossa (two left, two right). One kidney was foun d at the left iliac fossa just above the pelvic brim, one at the left lumba r region, and the other at: the right iliac fossa. Laparoscopic nephrourete rectomy was successful in all seven girls and the patients were discharged 48 h after surgery. The follow-up (mean 2.7 years, range 3 months-5.4 years ) showed excellent cosmetic results and all the patients have remained comp letely dry, Conclusions In patients with a classical picture of urinary incontinence ca used by infrasphincteric ureteric ectopia associated with a small nonfuncti oning kidney, video-laparoscopy, with its magnifying effect, cant reliably confirm the diagnosis, locate the dysplastic kidney and allow its removal i n the same setting. We propose that laparoscopy should be considered the in vestigation and treatment of choice in such patients, and should be underta ken without delay even if the dysplastic kidney or the ectopic ureteric ori fice cannot be identified with all other conventional means.