Ureterocalicostomy in children: 12 years experience in a single centre
Anna R Radford1, David F M Thomas, Ramnath Subramaniam
1Department of Paediatric Urology, Leeds General Infirmary, St James's University Hospital, Leeds, UK. annaradford@doctors.net.uk
Insights
Ureterocalicostomy is a successful surgical option for children with kidney obstruction, including complex cases like horseshoe kidney. This procedure offers good outcomes in most cases, with key surgical steps ensuring patient success.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Anatomy
Background:
- Ureterocalicostomy is a surgical technique to address urinary tract obstruction.
- Indications include primary and recurrent pelvi-ureteric junction obstruction, and complex renal anomalies like horseshoe kidney.
Purpose of the Study:
- To evaluate the outcomes of ureterocalicostomy in pediatric patients.
- To identify critical surgical steps for successful outcomes.
Main Methods:
- Retrospective review of 13 children undergoing ureterocalicostomy between 1997 and 2009.
- Procedures included primary and secondary interventions for pelvi-ureteric junction obstruction.
- Surgical approaches were open (12 patients) and laparoscopically-assisted (1 patient).
Main Results:
- A total of 12 out of 13 children (92%) had good functional outcomes, evidenced by reduced dilatation and improved drainage.
- One child experienced anastomotic obstruction post-procedure but had a successful surgical revision.
- Mean follow-up was 2.6 years.
Conclusions:
- Ureterocalicostomy is a versatile and reliable procedure for pediatric urinary obstruction.
- Key surgical techniques involve precise approximation of urothelium and judicious renal parenchyma excision.
- The procedure is effective for various indications, including horseshoe kidney and recurrent obstruction.
Objective:
• To document the outcome of ureterocalicostomy in children.
Patients And Methods:
• The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively. • Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi-ureteric junction (PUJ) obstruction. • In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty. • An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically-assisted technique.
Results:
• Mean age at operation was 9.3 years and the mean (range) duration of follow-up was 2.6 (0.3-7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging. • However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow-up to 3 years.
Conclusions:
• Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. • Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.
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