Reimplantation of obstructive megaureters with and without tailoring

Area of Science:

• Pediatric Urology
• Surgical Techniques
• Ureteral Reconstruction

Background:

• Megaureters can lead to obstruction, necessitating surgical intervention.
• Current surgical approaches for megaureters include tailoring (plication or excisional tapering) or non-tailoring reimplantation.
• There is variability in practice regarding whether to tailor megaureters during reimplantation.

Purpose of the Study:

• To compare the success rates of megaureter reimplantation with and without tailoring in pediatric patients.
• To evaluate complications associated with each surgical approach.

Main Methods:

• Retrospective review of medical records for 38 primary obstructive megaureters in 34 children (30 boys, 4 girls).
• Patients were divided into two groups: those undergoing tailored reimplantation (16 ureters) and non-tailored reimplantation (22 ureters).
• Outcomes assessed included resolution or improvement of hydronephrosis and post-operative complications.

Main Results:

• Non-tailored reimplantation showed higher rates of hydronephrosis resolution (50%) compared to tailored reimplantation (19%).
• Both methods demonstrated improvement in hydronephrosis (69% tailored, 45% non-tailored).
• Complications included anastomotic stricture (1/16 tailored) and recurrent urinary tract infections (1/16 tailored, 4/22 non-tailored).

Conclusions:

• Non-tailoring reimplantation is an equivalent and effective option to tailoring for obstructive megaureters.
• The choice between tailoring and non-tailoring may depend on surgeon preference and specific patient factors, with non-tailoring showing comparable or better outcomes in this series.