[Surgical correction of multiple ureter obstructions in children]

Obstruction in the pyeloureteral region is often combined with an obstacle of an anatomical or functional character in the distally located parts of the ureter. The authors treated by operation 80 patients with congenital hydronephrosis in the period from 1986 to 1991. An additional distally located stricture of the ureter was found during intraoperative catheterization in 10 cases. In 9 of 10 cases the obstacle was at a distance of 1.7-2.0 cm from the pelvioureteral junction. Due to the small distance between the strictures the affected segment could be resected and an Andersen-Haynes anastomosis formed. The authors believe that the presence of double obstructions indicates marked dysplastic changes of the ureteral wall. In view of this, the use of optic magnification, microsurgical instruments, and ultrathin suturing material in the formation of the anastomosis is recommended. In 3 children operated on by the above discussed method the postoperative course was uneventful. A clinical case is given in illustration. It is suggested in the discussion that the indications for retrograde pyelography may be widened so as to identify additional strictures of the ureter at the diagnostic stage.