Primary ureterocalycostomy for severe hydronephrosis in children

Fourteen children are described in whom primary ureterocalicostomy was performed for severe hydronephrosis due to pyeloureteral obstruction. Seven of them presented a horseshoe kidney. After a follow-up varying from 1 to 6 1/2 yr, clinical and radiologic improvement was obtained in 12 patients. Exclusion of decompensated renal pelvis and formation of strictly declivous drainage system, especially benefiaial in the case of horseshoe kidney, are two advantages of this procedure. The most important technical consideration is adequate resection of the renal cortex in order to free the large ureterocaliceal anastomosis from the surrounding cortical tissue. It is concluded that primary ureterocalicostomy is the operation of choice for hydronephrosis associated with a horseshoe kidney. This procedure is not advised, however, for simple though severe, hydronephrosis.