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Transureteroureterostomy as an adjunctive antireflux procedure in children undergoing bladder augmentation for
Tarun John K Jacob1, Cenita James Sam2, Jujju Jacob Kurian1
1Department of Paediatric Surgery, Christian Medical College, Vellore, India.
Insights
Transureteroureterostomy (TUU) is a safe procedure for children with neurogenic bladders and high-grade reflux undergoing augmentation cystoplasty. It effectively manages vesicoureteric reflux and hydroureteronephrosis, minimizing ureteric reimplantation.
Area of Science:
- Pediatric Urology
- Urological Reconstruction
- Nephrology
Background:
- Transureteroureterostomy (TUU) facilitates urinary drainage from both kidneys to the bladder via a single ureter.
- It is a valuable technique in complex urological reconstructions, particularly for children with neurogenic bladders and high-grade reflux undergoing augmentation cystoplasty.
Purpose of the Study:
- To evaluate the use, advantages, and complications of Transureteroureterostomy (TUU) in children with neurogenic bladders and high-grade vesicoureteric reflux (VUR) who have undergone augmentation cystoplasty (BA).
Main Methods:
- A retrospective review of 18 children (average age 5 years) with neurogenic bladders and high-grade VUR who underwent TUU and BA at two institutions.
- Management strategies included refluxing to non-refluxing TUU for unilateral VUR and unilateral reimplantation with TUU for bilateral VUR, minimizing ureteric reimplantation.
Main Results:
- All 18 children presented with bilateral hydroureteronephrosis and 30 refluxing megaureters.
- TUU successfully managed VUR and improved/stabilized hydroureteronephrosis in all but one child, with complete VUR resolution on follow-up cystograms.
- Serum creatinine remained normal in most cases, and TUU offered advantages like a catheterizable channel and ease of undiversion. A rare complication of TUU site stricture was managed with a cecal patch.
Conclusions:
- Transureteroureterostomy (TUU) is a safe and effective adjunctive procedure for children undergoing augmentation cystoplasty for neurogenic bladder with high-grade VUR.
- TUU minimizes the need for ureteric reimplantation in complex cases involving unhealthy bladders.
Introduction:
Transureteroureterostomy (TUU) provides urinary drainage of both renal systems to the bladder via a single ureter and is useful in selected situations of complex urological reconstructions. Herein we discuss its use, advantages and complications in children with neurogenic bladders and high-grade (4/5) reflux who have undergone augmentation cystoplasty.
Patients And Methods:
Children with neurogenic bladder complicated by unilateral or bilateral high-grade vesicoureteric reflux (VUR), who underwent TUU along with augmentation cystoplasty (BA), were selected from two institutions. Eighteen children with an average age of 5 years at presentation were identified from a retrospective chart review.
Results:
All had bilateral hydroureteronephrosis (HUN) of which there were 30 refluxing megaureters. While BA reduced bladder pressure, VUR was managed by refluxing to non-refluxing TUU in six cases with unilateral VUR and unilateral reimplantation with TUU to the reimplanted ureter in 12 cases of bilateral VUR, thus minimizing reimplantation to 12 of 30 ureters. The average time of follow-up was 51 months. Follow-up cystograms showed complete resolution of VUR in all. HUN improved/stabilized in all but one child. Serum creatinine remained normal in all but two cases. Other advantages of TUU include the use of the distal ureter as a catheterizable channel and ease of undiversion when the ureter has been diverted as a ureterostomy. An unusual complication of a TUU site stricture is discussed and the innovative technique of using a cecal patch to salvage the anastomosis is detailed.
Conclusion:
We conclude that a TUU is a safe and useful adjunctive procedure in children undergoing BA for neurogenic bladder with high-grade VUR, minimizing the need for ureteric reimplant in an unhealthy bladder.
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