Partial nephroureterectomy in a duplex system in children: the need for additional bladder procedures.

Area of Science:

• Pediatric Urology
• Surgical Management of Duplex Systems

Background:

• Heminephroureterectomy (HN) is a primary treatment for non-functioning moieties in duplex systems.
• The necessity of additional procedures like endoscopic incision (EI) or bladder reconstructive surgery (BRS) in conjunction with HN requires further elucidation, particularly concerning ureteroceles and vesicoureteric reflux (VUR).

Purpose of the Study:

• To evaluate the impact of ureteroceles and VUR on the requirement for EI/BRS in patients undergoing HN for duplex systems.
• To determine if ureteroceles influence the need for additional bladder surgery beyond HN.

Main Methods:

• Retrospective analysis of 31 pediatric patients who underwent HN by a single surgeon between 2003 and 2008.
• Patients were categorized based on the presence (Group 1) or absence (Group 2) of ureterocele, and further subdivided by the presence of dilating VUR (a) or absence (b).
• Statistical analysis, including Fisher's exact test, was employed to compare outcomes between groups.

Main Results:

• Seventeen patients (54.8%) had ureteroceles (Group 1), and 14 did not (Group 2).
• Significantly more patients with ureteroceles required EI/BRS (29% in Group 1 vs. 0% in Group 2, p = 0.04).
• Patients with ureterocele and VUR (Group 1a) showed a higher incidence of EI prior to HN compared to those without VUR (75% vs. 33%, p = 0.04).

Conclusions:

• In the absence of ureteroceles, HN alone is generally sufficient, irrespective of VUR.
• The presence of a ureterocele is a strong predictor for requiring additional procedures within the bladder.
• Co-existing ureteroceles and dilating VUR increase the likelihood of needing endoscopic incision before HN.