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Extensive upper and mid ureteral loss in newborns: experience with reconstruction in 2 patients
John F Redman1, Meredith L Lightfoot, Pramod P Reddy
1Department of Urology, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Insights
Pediatric ureteral reconstruction for extensive loss in newborns is successful using renal mobilization with Boari flaps or ureteropyelostomy. These techniques effectively bridge ureteral defects, ensuring positive outcomes without obstruction.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Ureteral Surgery
Background:
- Neonatal ureteral loss can result from infections like candidiasis.
- Extensive ureteral defects pose significant surgical challenges in infants.
Observation:
- Two male infants experienced significant ureteral loss due to candidal infection.
- One patient had mid-ureteral loss, the other had upper ureteral loss.
Findings:
- Successful reconstruction was achieved using renal mobilization combined with a Boari flap for mid-ureteral loss.
- Renal mobilization, nephropexy, and primary ureteropyelostomy successfully reconstructed upper ureteral loss.
- Both pediatric patients demonstrated successful outcomes with no anastomotic stenosis or obstruction.
Implications:
- Standard surgical techniques can effectively manage extensive ureteral defects in neonates.
- Renal mobilization, Boari flaps, and ureteropyelostomy are viable options for pediatric ureteral reconstruction.
- Early and successful ureteral repair in infants prevents long-term complications.
Purpose:
We describe our experience with reconstruction of the ureter in 2 patients who sustained extensive upper and mid ureteral loss as newborns.
Materials And Methods:
Two male patients, a 1-month-old and a neonate, sustained extensive ureteral loss due to candidal infection involving the retroperitoneum and ureter. The 1-month-old sustained a loss of the middle third of the ureter, and the neonate sustained a 3 cm. loss of the upper ureter. The first case was managed with a combination of renal mobilization and an extensive Boari flap, while the second was managed with renal mobilization and nephropexy with primary ureteropyelostomy.
Results:
Both patients had a successful outcome with no evidence of anastomotic stenosis or obstruction.
Conclusions:
Extensive upper and middle third ureteral defects may be primarily bridged successfully in pediatric patients using the standard technique of renal mobilization combined with ureteropyelostomy and a Boari flap, respectively.