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Published on: December 20, 2014
Ureteroureterostomy as Definitive Intervention for Duplex Anomalies: A Mid-Term Analysis
Sahar Eftekharzadeh1, Aznive Aghababian2, Suhaib Abdulfattah2
1Department of Urology, Jefferson Einstein Medical Center, Philadelphia, PA; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Robot-assisted laparoscopic ureteroureterostomy (UU) and open UU are safe and effective for treating duplicated collecting systems in children. Mid-term follow-up shows good outcomes, with constipation being a predictor of febrile urinary tract infections (f-UTI).
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Reconstruction
Background:
- Duplicated collecting systems are a common congenital anomaly in children.
- Ureteroureterostomy (UU) is a surgical procedure to correct these anomalies, often indicated for obstruction or vesicoureteral reflux (VUR).
- Evaluating the mid-term outcomes of different surgical approaches is crucial for optimal patient management.
Purpose of the Study:
- To conduct a mid-term evaluation (3-10 years post-op) of children with duplicated collecting systems treated with ureteroureterostomy (UU).
- To compare outcomes between robot-assisted laparoscopic UU and open UU surgical approaches.
Main Methods:
- Retrospective review of a single-institutional registry of patients undergoing UU for duplex renal anomalies (2014-2020).
- Inclusion criteria: minimum 3-year follow-up with available post-operative imaging.
- Data collected: febrile urinary tract infection (f-UTI), flank pain, renal function, imaging findings, and need for re-operation.
Main Results:
- 42 patients met inclusion criteria (36 robot-assisted laparoscopic UU, 6 open UU).
- No significant difference in procedure length between groups; open UU cohort was younger.
- Constipation was the only predictor of f-UTI (OR: 6.6). 98% showed stable or improved dilation; 7% developed de novo hydronephrosis, all asymptomatic.
Conclusions:
- Robot-assisted laparoscopic UU and open UU are safe and effective for managing duplicated collecting systems with obstruction or VUR.
- Mid-term outcomes are favorable for both surgical approaches.
- Yo-yo reflux is rarely diagnosed and clinically insignificant.
Objective:
To provide a mid-term evaluation-defined as 3 to 10 years of post-operative follow up-of children with duplicated collecting systems undergoing ureteroureterostomy. In addition, a sub stratified analysis based on surgical approach is delivered to compare outcomes between the two approaches.
Materials And Methods:
An IRB-approved single-institutional registry was retrospectively reviewed to identify all patients undergoing ureteroureterostomy (UU) for duplex renal anomalies between 2014 and 2020. Only children with a minimum 3 years follow-up with available post-operative imaging were included in the study. Details including incidence of febrile UTI (f-UTI), flank pain, post-operative renal function, ultrasound findings, and need for further surgical intervention at follow-up were aggregated to assess mid-term outcomes.
Results:
During the study period, 78 patients underwent UU, 42/78 patients met the inclusion criteria: 36 robot-associated laparoscopic UU, and 6 open UU (OUU). OUU cohort was significantly younger (0.35 vs 2.5 years, P = .002). There was no statistical difference in procedure length between the 2 groups (180.5 vs 203.5 minutes, P = .68). Multivariate logistic regression demonstrated that constipation at the most recent follow-up was the only predictor of f-UTI (OR: 6.6, 95%CI 1.5-28.5, P = .01). Imaging at a median of 60 months post-operatively showed resolved, improved, or stable dilation of the operated moiety in 41 (98%) patients. De novo hydronephrosis of the recipient moiety was found in 3 (7%) patients at the most recent follow-up imaging, with UTD-P1 in 2 patients and UTD-P2 in 1 patient-likely secondary to intermittent constipation. Of these 3 patients, all were asymptomatic, and none experienced post-operative f-UTI.
Conclusions:
At mid-term follow-up, robot-associated laparoscopic UU and OUU are safe and effective approaches for management of duplicated collecting systems with obstruction or vesicoureteral reflux (VUR). Additionally, yo-yo reflux is uncommonly diagnosed and clinically irrelevant.
