Ipsilateral ureteroureterostomy: does function of the obstructed moiety matter?

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Renal Collecting System Abnormalities

Background:

• Duplex renal collecting systems with upper pole moieties, ureteral ectopia, and ureterocele traditionally undergo upper pole nephrectomy.
• Ablative surgery risks functional loss in the remnant moiety due to vasospasm or vascular injury.
• Ipsilateral ureteroureterostomy (IUU) is explored as an alternative to nephrectomy.

Purpose of the Study:

• To evaluate the safety and feasibility of IUU in managing children with duplex systems and upper pole obstruction.
• To determine if residual function in the obstructed upper pole impacts surgical outcomes.
• To compare outcomes between patients with <10% and ≥10% upper pole moiety function (UPMF).

Main Methods:

• Retrospective review of 53 children with duplex systems undergoing IUU (2010-2016).
• Patients categorized into two groups based on pre-operative UPMF: <10% and ≥10%.
• Outcomes assessed included postoperative complications (Clavien-Dindo), need for secondary surgery, and radiological results.

Main Results:

• No significant differences in postoperative complications, secondary surgery rates, or radiological outcomes were observed between the <10% UPMF and ≥10% UPMF groups.
• Prenatal hydronephrosis was the most common presentation in both groups.
• No patient required secondary surgery.

Conclusions:

• Ipsilateral ureteroureterostomy (IUU) is a safe and definitive surgical intervention for duplex collecting systems.
• IUU effectively preserves renal architecture in pediatric patients.
• The procedure's success is independent of the upper pole moiety's residual function.