# Simultaneous Bilateral Pediatric Nephrectomies: Indications, Approach and Outcomes Over a 15‐Year Period

## TL;DR

This paper examines the safety and effectiveness of removing both native kidneys at once in children with severe kidney disease over a 15-year period.

## Contribution

The study provides a detailed single-center analysis of indications, surgical approaches, and outcomes of simultaneous bilateral native nephrectomies in pediatric patients.

## Key findings

- Ten pediatric patients underwent simultaneous bilateral native nephrectomy over 15 years with no major complications.
- Both open and minimally invasive approaches were used successfully, with dialysis restart possible within a day in some cases.
- The procedure was found to be safe and effective for managing end-stage renal disease in children.

## Abstract

Reports on bilateral simultaneous native nephrectomies in the pediatric population are lacking. This study evaluates indications and outcomes of a tertiary care pediatric hospital's single center experience with bilateral simultaneous native nephrectomies over 15 years.

A retrospective chart review of pediatric patients (< 21 years old) who underwent bilateral simultaneous native nephrectomy from January 1, 2009, to August 1, 2024, at a single institution was performed for surgical indications, approach, and outcomes.

Ten patients were identified. Mean age at bilateral simultaneous nephrectomy was 9.6 years (range 14 months–19 years). Surgical indications included hypertensive crisis in four, nephrotic syndrome in three, Polycythemia Vera in one, recurrent urinary tract infections (UTI) in one, and significant hydroureteronephrosis in one patients. Prior to nephrectomy, six patients were on hemodialysis, two patients were on peritoneal dialysis (PD), and two patients were not on any form of dialysis. Of the 10 patients, four underwent surgery during an inpatient admission for an acute exacerbation of the listed indication. Three cases were done robotically (transperitoneal), and seven were performed open. Both patients on PD preoperatively underwent open retroperitoneal surgery and were able to restart PD on postoperative day 1. There was one complication in a patient with recurrent UTIs who developed an intra‐abdominal abscess, requiring percutaneous drainage.

Bilateral simultaneous native nephrectomy is a safe and effective way to manage conditions associated with end‐stage renal disease in pediatric patients. In our experience, this can be done by an open or minimally invasive approach.

Our single‐institution 15‐year experience with simultaneous bilateral native nephrectomy (BNN) in pediatric patients demonstrates utility and safety. We discuss considerations of BNN relative to timing of transplantation, an area of conversation. We demonstrate that a minimally invasive approach is feasible, and the surgical approach should consider the route of current or planned dialysis.