The use of topical vasodilators as an adjunct in infant renal surgery

In infant renal surgery there is a well recognized problem with vasospasm and resultant renal ischemia. Recently, we applied vasodilators to the perivascular tissues during renal surgery to prevent vasospasm. With this mode of treatment no renal units were lost owing to ischemia secondary to the operative procedure. The treatment has been especially useful in infants with duplicated systems undergoing partial nephroureterectomy. Owing to the diminutive size of infant renal vessels, vasospasm can be triggered easily even with the most careful hilar dissection. Thus, to assure maximal preservation of tissue, vasospasm must be prevented before renal mobilization and hilar dissection. Therefore, to prevent the development of renal ischemia in infants undergoing renal surgery we recommend 1) initial exposure of the hilar vessels before dissection, 2) application of papaverine and lidocaine to the perivascular tissues, and 3) delaying further dissection until maximal vasodilation has occurred.