Long-term outcome analysis of Starr plication for primary obstructive megaureters

Area of Science:

• Pediatric Urology
• Surgical Outcomes
• Renal Function Preservation

Background:

• The Starr technique for tapering megaureters was described in 1979.
• Clinical outcome data for the Starr ureteral plication technique are limited.
• Primary obstructive megaureter management requires effective surgical strategies.

Purpose of the Study:

• To report the first long-term clinical outcomes of the Starr technique for primary obstructive megaureters.
• To evaluate the safety and efficacy of ureteral plication in pediatric patients.
• To assess the impact of the Starr technique on renal function.

Main Methods:

• Retrospective review of 13 patients (10 boys, 3 girls) with 16 primary obstructive megaureters treated between 1988 and 2000.
• All ureters underwent plication using the Starr technique with polydioxanone sutures.
• Reimplantation utilized the Hendren (7) or Politano-Leadbetter (9) techniques.
• Renal function assessed via renal scan and 24-hour urinary creatinine clearance, with an average follow-up of 6.2 years.

Main Results:

• No postoperative ureteral obstruction was observed.
• One case of reflux resolved with subureteral collagen injection.
• Creatinine clearance significantly improved (p <0.05) from a mean of 72.9 to 102.1 cc/min.
• Renal scans showed stable relative renal function (average 53.0% preoperatively vs. 53.3% postoperatively) over an average follow-up of 4.1 years.

Conclusions:

• Starr plication is a safe and effective surgical procedure for primary obstructive megaureters.
• The technique provides long-term stabilization of renal function.
• This study provides the first clinical evidence supporting the use of the Starr technique.