Indications for nephrectomy in children: a report on 119 cases.

The objective of the study is to review the indications for nephrectomy in children. This study was conducted in the Division of Pediatric Surgery at the King Hussein Medical Center, Amman, Jordan, between the years 1997 and 2009. The medical records of 119 of 141 patients who underwent nephrectomy were reviewed. The patients included 67 males and 52 females, and their ages ranged from two months to 13 years. The study patients underwent simple or radical nephrectomy or nephron-sparing surgery during the 13-year period. They were studied with regard to gender, age, indication for nephrectomy, morbidity and mortality. The indications for nephrectomy were divided into benign and malignant conditions. Of the 119 nephrectomies performed, 49 patients (41.2%) had malignant conditions and 70 (58.8%) had a benign etiology. In the benign group, 23.5% of the patients underwent nephrectomy for complicated vesicoureteric reflux, urinary tract stones or infection (1.6%). Other conditions in this group included ureterocele, posterior urethral valve, etc. Benign conditions and ureterocele necessitating nephrectomy were predominant in female patients, while pelvi-ureteric junction obstruction was predominant in males. The malignant lesions necessitating nephrectomy included Wilms tumor and neuroblastoma. The over-all mortality rate was nil in the absence of malignancy. Obstructive nephropathy was the main cause of nephrectomy in this series, followed by malignancy of the kidney. It remains to be seen whether better management will reduce the incidence of nephrectomies in preventable cases. It is also important that children with a solitary functioning kidney have long-term follow-up.