Ipsilateral ureteroureterostomy: does function of the obstructed moiety matter?

T. Kawal, A. K. Srinivasan, R. Talwar, David I-Wang Chu, C. Long, D. Weiss, J. Van Batavia, T. F. Kolon, A. R. Shukla*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Purpose: Upper pole nephrectomy has been the traditional surgical management of children with poorly functioning upper pole moieties in duplex renal collecting systems having ureteral ectopia and ureterocele. However, ablative surgery confers a risk of functional loss to the remnant moiety due to vasospasm or vascular injury. It was hypothesized that ipsilateral ureteroureterostomy (IUU) is a safe and feasible approach for the management of these patients and that residual function in the obstructed upper pole does not affect surgical outcomes. Materials and methods: All patients with duplex systems who underwent IUU between 2010 and 2016 were retrospectively reviewed. Patients were sorted into two groups based on pre-operative imaging: those having <10% upper pole moiety function (UPMF) and those having ≥ 10% UPMF. Outcomes assessed were postoperative complications (Clavien–Dindo classification), need for secondary surgery, and radiological outcomes. Results: The study cohort comprised 53 children with ectopia or ureterocele affecting the upper pole in a duplex system, 21 with UPMF <10% (median function 0% and median age 1.49 years) and 32 with UPMF ≥ 10% (median function 15% and median age 0.91 years). Median follow-up was 27.4 months and 27.6 months. In both the groups, prenatal hydronephrosis was the most common presentation (57% and 56%, respectively; p = 0.18) followed by urinary tract infection. Mann–Whitney U test comparing the two groups revealed no significant differences in any of the outcomes assessed. No patient required secondary surgery. Conclusion: Ipsilateral ureteroureterostomy is a safe, definitive surgical intervention that preserves the renal architecture in children with duplex collecting systems regardless of upper pole function.[Figure presented]

Original languageEnglish (US)
Pages (from-to)50.e1-50.e6
JournalJournal of Pediatric Urology
Volume15
Issue number1
DOIs
StatePublished - Feb 2019

Funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (grant number T32-DK007785-14 to DIC). The NIDDK had no role in the design of and in conducting the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the official view of the NIDDK.

Keywords

  • Duplex kindey
  • Ectopic ureter drop
  • Obstructed moiety function
  • Obstructed moiety function
  • Ureteroureterostomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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