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Published on: December 20, 2014
Open distal ureteroureterostomy for non-refluxing duplicated collecting system in children: Multicentric study and
Maria Veronica Rodriguez1, Paola Pena2, Eliana Vargas3
1Urology Department at Doctors Hospital at Renaissance, 5501 S McColl Rd, Edinburg, TX 78539, USA.
Insights
Open distal ureteroureterostomy (UU) effectively treats ureteroceles and ectopic ureters without lower pole VUR. This multicenter study shows high success rates, low morbidity, and short recovery times for this surgical approach.
Area of Science:
- Pediatric Urology
- Surgical Management of Congenital Anomalies
Background:
- Ureteroceles and ectopic ureters in duplicated collecting systems often require surgical intervention.
- Surgical approaches include upper or lower urinary tract procedures, or combined methods.
- Open ureteroureterostomy (UU) is a described technique for these conditions, particularly when lower pole (LP) vesicoureteral reflux (VUR) is absent.
Purpose of the Study:
- To report outcomes of open distal UU for duplicated collecting systems without LP VUR.
- To evaluate the efficacy and safety of this surgical approach in a multicenter setting.
- To assess mid-term follow-up results.
Main Methods:
- Retrospective review of patient records and imaging from North America, South America, and the Caribbean.
- Inclusion criteria: children undergoing open distal UU for duplicated collecting systems without LP VUR.
- Descriptive statistics and univariate analysis were employed.
Main Results:
- 127 patients underwent open distal UU between 2009 and 2022; 65% were female, mean age 18 months.
- Presentations included prenatal hydronephrosis (64%), febrile UTIs (28%), and incontinence (8%).
- 98% showed sonographic improvement or symptom resolution; success rates were high for both ureterocele (100%) and ectopic ureter (97%) subgroups. Complication rates were low (Clavien-Dindo grades I-IIIb in 9%).
Conclusions:
- Open distal UU is a viable surgical option for ureteroceles and ectopic ureters without LP VUR.
- The procedure demonstrates high success rates, minimal morbidity, and short hospital stays.
- Further research is needed to clarify UU's role in cases with ipsilateral LP VUR.
Background:
When indicated, ureteroceles and ectopic ureters in duplicated collecting systems can be managed via upper or lower urinary tract surgical approaches, or a combination of both. Open ureteroureterostomy (UU) has been described to address these conditions in the absence of lower pole (LP) vesicoureteral reflux (VUR). We report outcomes from multiple centers worldwide with mid-term follow-up.
Methods:
Our study consists of a retrospective review of records and imaging of children who underwent open distal UU via inguinal incision for duplicated collecting system without lower pole VUR in institutions from North America, South America, and the Caribbean. Descriptive statistics and univariate analysis were utilized.
Results:
The records of 127 patients who underwent open distal UU for double collecting system between 2009 and 2022 were reviewed. Of those, 65% were female (n = 82), with a mean age at operation of 18 months (range 3-180). Main presentation at surgery included prenatal hydronephrosis (64%, n = 81), followed by febrile urinary tract infections (28%, n = 36), and urinary incontinence or other (8%, n = 10). The patients with antenatal or incidental diagnosis of hydronephrosis were classified as preoperative Society for Fetal Urology (SFU) grade 3 (n = 64) and 4 (n = 54) (96%). Those who were classified with SFU grade 0-2 (4%) had symptomatic clinical presentations including febrile urinary tract infections (UTIs) (n = 3), urinary incontinence (n = 3), and a 12-year-old patient with recurrent abdominal pain (n = 1). Mean operative time from skin incision to skin closure was 86 min (range 45-240). Mean hospital stay was estimated at 1.1 days (range 0.5-4). In our cohort of 127 patients, 3 (2%) developed Clavien-Dindo grade I (2 with ureteral stent displacement and 1 with a urine leak/managed conservatively), 6 (5%) with grade II (3 febrile and 3 non-febrile UTIs managed with oral antibiotics), and 2 (2%) with grade IIIb complications (urine leaks requiring surgical management), which were appropriately treated. None presented grade IV or V complications. A double J stent was used in 56 patients (44%), and a Penrose drain was left in 10 (8%). A total of 125 children (98%, n = 125/127) showed sonographic improvement of hydronephrosis, or resolution of symptoms with stable ultrasound findings. Successful outcome was similar for both ureterocele and ectopic ureter subgroups: 49/49 patients with ureterocele showed 100% improvement, 76/78 children with ectopic ureter showed improvement in 97% of the cases. On univariate analysis, outcomes were similar regardless of the use of ureteral stents (p = 0.11). Mean follow-up was 28.2 months (range 12-85).
Conclusions:
Open distal UU is a good alternative for the definitive surgical management of ectopic ureters and ureteroceles without LP VUR. This multicentric and mid-term follow-up study demonstrates that open distal UU offers high success rates, low morbidity, short operative times and hospital stays, and satisfactory aesthetic outcomes. Additionally, the surgery is performed extra-peritoneally and may not require the use of stents or drains, depending on surgeon preference. Further investigations are being conducted to determine the role of UU in the settings of double collecting systems associated with ipsilateral LP VUR.
