373 / 492
VR-12
(VS)
LAPAROSCOPIC EXCISON OF JUXTAGLOMERULAR CELL TUMOUR
Maurizio PACILLI, Yves HELOURY and Mike O'BRIEN
Royal Children's Hospital, Urology, Parkville - Melbourne, AUSTRALIA
PURPOSE
We report a case of juxtaglomerular cell tumour of the kidney (reninoma) treated with laparoscopic nephron sparing
surgery
MATERIAL AND METHODS
A 14-year old girl was incidentally found to have hypertension (180/114 mmHg) at the time of adenotonsillectomy.
Prep-operative investigations revealed plasma renin level of 225.9 ng/dL (4.4-46), normal aldosterone, cortisol and
urinary cathecolamines. Abdominal ultrasound detected a 1.9x1.5 cm hypoechoic lesion in the right kidney lower pole;
CT scan confirmed the presence of a 1.5 cm, well circumscribed, solid, hypoenhancing cortical lesion in the right lower
pole. The blood pressure was controlled with ACE inhibitors and calcium channel blocker. At the time of surgery, a right
J-J stent was placed. Laparoscopic nephron sparing surgery was accomplished by clamping the renal artery for 30
minutes (video); after excision the tumour bed was closed using barbed V-loc stures.
RESULTS
The procedure was completed laparoscopically in 150 minutes with no peri-operative complications. Patient was
discharged home on day 4 post-op. Histology confirmed the diagnosis of juxtaglomerular cell tumour completely
excised. The J-J stent was removed one month later. At follow-up the patient’s blood pressure was normalized and
medications were stopped. A DMSA scan performed 3 months later confirmed 36% residual function of the right kidney.
CONCLUSIONS
Laparoscopic nephron sparing surgery should be considered in children with juxtaglomerular tumour. This technique
allows prompt recovery with preservation of significant renal function