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Updated: Jun 28, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-up and Outcomes After
Adree Khondker1,2, Mandy Rickard1, Jin Kyu Kim1,2
1Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Ureterovesicostomy (UV) offers a safe surgical option for primary obstructive megaureter (POM) in children. This procedure can improve upper tract dilation with manageable complications and a low reoperation rate.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Urologic Reconstruction
Background:
- Primary obstructive megaureter (POM) is a congenital condition requiring surgical intervention.
- Ureterovesicostomy (UV) is a surgical technique used to manage POM.
- Long-term outcomes of UV for POM are not well-established.
Purpose of the Study:
- To evaluate the long-term outcomes of ureterovesicostomy (UV) in children with primary obstructive megaureter (POM).
- To assess complications, including urinary tract infections (UTIs) and the need for reimplantation, after UV for POM.
Main Methods:
- Retrospective analysis of children with POM who underwent refluxing UV between 2016 and 2023.
- Assessment of surgical outcomes, complication rates (UTIs, reoperations), and changes in upper tract dilatation.
- Statistical analysis of hydronephrosis metrics during follow-up.
Main Results:
- Out of 183 POM patients, 47 underwent UV. Median follow-up was 43 months.
- Short-term complications included transient urinary retention and UTIs. 30% of patients developed UTIs during monitoring, and 15% required reoperation.
- Significant improvement was observed in high-grade hydronephrosis, renal pelvis diameter, and ureteral dilatation post-surgery.
Conclusions:
- Refluxing UV is a safe alternative to cutaneous diversion for POM.
- UV provides improvement in upper tract dilatation with acceptable short-term complications and reoperation rates.
- Selective reconstruction after UV is a feasible strategy, allowing for monitoring.
Purpose:
We describe long-term outcomes, including UTIs and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructive megaureter (POM).
Materials And Methods:
Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other etiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up.
Results:
Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1 in 2 (transient urinary retention) and grade 2 in 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter, and maximum ureteral dilatation.
Conclusions:
Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for reoperation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy.
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