Related Experiment Videos
Successful use of transureteroureterostomy in children: a clinical study
C Pesce1, L Costa, P Campobasso
1Division of Pediatric Surgery, S. Bortolo Hospital, Vicenza, Italy.
Insights
Transureteroureterostomy is a valuable salvage procedure for pediatric urological anomalies, particularly after failed ureteroneocystostomy. Long-term monitoring is crucial for children with neurogenic bladder undergoing this surgery.
Area of Science:
- Pediatric Urology
- Surgical Procedures
- Urological Anomalies
Background:
- Transureteroureterostomy (TUU) is a reconstructive surgical technique.
- Its role in managing complex pediatric urological conditions requires further evaluation.
- Long-term outcomes, especially in patients with neurogenic bladder, are of significant interest.
Purpose of the Study:
- To assess the current role of transureteroureterostomy in pediatric patients.
- To evaluate the long-term safety and efficacy of TUU in children with neurogenic bladder.
- To review outcomes in a cohort of pediatric patients undergoing TUU.
Main Methods:
- Retrospective review of 70 pediatric patients (ages 2-13) who underwent transureteroureterostomy from 1972 onwards.
- Analysis of TUU's use as a salvage procedure versus a diversion procedure.
- Evaluation of postoperative complications and long-term sequelae, particularly in patients with neurogenic bladder.
Main Results:
- Transureteroureterostomy was employed as a salvage procedure in 97% of cases after failed ureteroneocystostomy.
- The procedure had a low rate of early complications, with one case of anastomotic occlusion successfully managed with stenting.
- No surgical revisions of the ureteral anastomosis were required.
- Four patients with neurogenic bladder (myelomeningocele) experienced sequelae including stenosis, vesicoureteral reflux, and calculi.
Conclusions:
- Transureteroureterostomy is a highly useful technique for managing diverse pediatric urological anomalies.
- It demonstrates effectiveness as a salvage procedure in challenging cases.
- Continued long-term surveillance is essential for pediatric patients with neurogenic bladder who undergo transureteroureterostomy to ensure favorable outcomes.
Abstract:
The purpose of this review of patients was to look at the current role of transureteroureterostomy in children. In addition, this study should give an indication of the long-term safety of transureteroureterostomy in children with neurogenic bladder. From 1972 on, 70 subjects between the ages of 2 and 13 underwent transureteroureterostomy. In 68 patients (97 %), transureteroureterostomy was used as a salvage renal procedure after unsuccessful ureteroneocytostomy attempts at other institutions. In 2 patients (3 %), transureteroureterostomy was used as a diversion procedure. The postoperative course was uneventful except for 1 case of early anastomotic occlusion successfully treated by application of a double-J stent. No patient required surgical revision of the ureteral anastomosis. However, 4 patients with neurogenic bladder from myelomeningocele developed sequelae. Of these, 1 presented with stenosis at the end of the recipient ureter, 2 had occurrence of vesicoureteral reflux in nonreimplanted recipient ureter, 1 developed calculi in the donor pelvis. This study supports the view that transureteroureterostomy is highly useful for the management of children with a wide spectrum of urological anomalies. However, long-term monitoring of patients with neurogenic bladder who have undergone this procedure is essential to achieve a long-term good outcome.