Open ureteroureterostomy for repair of upper-pole ectopic ureters in children with duplex systems: is stenting really
1Division of Urology, Department of Surgery, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada.
Insights
Routine ureteric stenting during ureteroureterostomy for ectopic upper-pole ureters in duplex kidneys is not necessary. Stenting led to more minor complications and required secondary procedures without improving outcomes.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Duplex Kidney Management
Background:
- Ectopic upper-pole (UP) ureters in duplex kidneys are surgically managed with ureteroureterostomy (U-U).
- The necessity of routine ureteric stenting during U-U for UP ureters lacks robust evidence.
Purpose of the Study:
- To evaluate outcomes of children with ectopic UP ureters undergoing distal U-U.
- To compare outcomes between routine ureteric stenting and stentless U-U procedures.
Main Methods:
- Prospective analysis of 47 consecutive patients with duplex collecting systems undergoing distal U-U for ectopic UP ureters.
- Patients were divided into routinely stented (30) and stentless (17) groups.
- Data collected included demographic information, operative factors, and postoperative complications.
Main Results:
- No significant differences in operative time, hospital stay, or hydronephrosis resolution between stented and stentless groups.
- Stented patients experienced minor complications (UTI, dysuria, stent displacement) and required secondary procedures for stent removal.
- 96% overall resolution of hydronephrosis was observed, with no major complications in either group.
Conclusions:
- Routine ureteric stenting in distal U-U for UP ectopic ureters is associated with increased minor complications and secondary procedures.
- Stenting may not be routinely necessary for managing UP ectopic ureters in duplex systems.
- Stentless U-U offers comparable outcomes with fewer complications.
Background:
Ectopic upper-pole (UP) ureters in duplex kidneys can be managed surgically by ipsilateral distal ureteroureterostomy (U-U) with or without ureteric stenting. Evidence to support routine stenting during this procedure is lacking.
Objective:
The authors present their outcomes of children with ectopic UP ureters who underwent ipsilateral distal U-U. They also compared outcomes of those who underwent routine ureteric stenting to those who did not.
Study Design:
Between 2009 and 2015, the authors performed a prospective analysis on consecutive patients with duplex collecting systems who underwent distal U-U via an inguinal incision for ectopic UP ureters by one of two pediatric urologists. The demographic information, operative factors, and any postoperative complications on follow-up were recorded.
Results:
The study included 47 patients (28 female) who underwent distal U-U with a mean age of 9.8 months. There were 30 patients who were routinely stented, and 17 who were not based on the routine practices of the operating surgeons without any selection bias. The mean operative time was 90 min, and the mean hospital stay was 0.9 days. No major complications were observed in this series, with 96% of patients showing resolution of hydronephrosis. There were no statistical differences between the stented and stentless U-U groups in terms of operative time, hospital stay, hydronephrosis resolution, time to resolution of hydronephrosis, and major complications. Only stented patients were found to have minor complications (2-urinary tract infection, 2-dysuria, and 2-stent displacement). All patients who underwent routine stent placement required a secondary planned procedure under general anesthesia for the cystoscopic removal of stent.
Conclusion:
Stenting was associated with a higher number of minor complications compared to the stentless group and thus, may not be routinely necessary when performing distal U-U for management of UP ectopic ureters associated with duplicated collecting systems.
More Related Videos
12:30Vascular Gene Transfer from Metallic Stent Surfaces Using Adenoviral Vectors Tethered through Hydrolysable Cross-linkers
Published on: August 12, 2014
08:26Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Related Concept Videos
01:22Ureters
01:24Pole and System Stability
Simple poles are unique roots of the denominator polynomial. Each simple pole corresponds to a distinct solution to the system's characteristic equation, typically resulting in exponential decay terms in the system's...
01:11Anatomy of the Genitourinary System I: Kidneys and Ureters
01:36Mismatch Repair
02:25Overview of DNA Repair
Chemically...
01:54Base Excision Repair
The first step of...