Renal transplantation: Fetal Genitourinary Disease 2015

Infants who make urine are not likely to need peritoneal dialysis immediately but will likely need it in the future

When placing both G-tube and PD catheter together, the PD catheter should be left alone for a couple of weeks if possible

Gastrostomy tube placement should focus on the lesser curvature to preserve the stomach for potential future bladder augmentation

Hemodialysis catheters need to be fairly large caliber and placement should stay as much as possible to the right internal jugular site because that is a straight shot into the atrium

Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis

If hernias are not affecting the mechanics of dialysis and not particularly symptomatic, they tend to be left alone

The ideal weight for infant renal transplant is around 10 kg if not on PD

Infants on PD can be transplanted closer to 8 kg because they have a more accommodating abdominal cavity and laxity in the abdominal wall

All infant recipients have been transplanted with adult donors

An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin

The biggest complication from a general surgical perspective in infant renal transplants are wound complications as opposed to vascular complications

Some infants can only have skin closed initially and develop leaks or dehiscence requiring biologic mesh (such as derma matrix) for closure

In a 13-year follow-up of G-tubes in babies, they all migrate up onto the chest

Placing G-tube too close to PD catheter creates infection risk early on because there is not enough space between sites and drainage can get underneath the PD catheter dressing

Standard G-tube insertion site is 2 finger breadths below the costal margin

In small babies, G-tube should be placed 3 or 4 finger breadths below costal margin because it will rise up with growth

G-tube location should be high up on the stomach towards lesser curvature to allow ability to use gastric segment for gastric augmentation later in life

Some babies with posterior urethral valves will need urinary diversion with vesicostomy about 1-2 finger breadths below the umbilicus, requiring G-tube placement away from this site to mitigate infection risk

PD catheters can be placed to allow immediate use with lower volumes rather than waiting 3-7 days

Amnioinfusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills

In fetal imaging, bladder and bladder wall thickness and isthmus are always measured

Early onset large bladders that extend up and push the diaphragm and stomach back may cause anatomic distortion that results in stomachs ending up higher long term