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Ectopic ureter with complete ureteric duplication: conservative surgical management
A el Ghoneimi1, J Miranda, T Truong
1Department of Pediatric Urology, Hopital d'enfants de la Timone, Marseille, France.
Insights
Conservative management of ectopic ureters in children with complete ureteric duplication is effective. Procedures like nephroureterectomy and ureterovesical reimplantation successfully treated incontinence and infections.
Area of Science:
- Pediatric Urology
- Surgical Management
- Congenital Anomalies
Background:
- Ectopic ureters are a congenital anomaly often associated with complete ureteric duplication.
- These anomalies can lead to significant morbidity, including urinary incontinence and recurrent urinary tract infections.
- Management strategies vary, with a need to assess the efficacy of conservative approaches.
Purpose of the Study:
- To evaluate the outcomes of conservative surgical procedures for ectopic ureters in children.
- To determine the success rates of different surgical techniques in managing ectopic ureters associated with complete ureteric duplication.
- To assess the long-term results of managing ectopic ureters in a pediatric population.
Main Methods:
- Retrospective review of 31 children (28 girls, 3 boys) aged 19 days to 10 years with ectopic ureters and complete ureteric duplication.
- Surgical interventions included upper pole nephroureterectomy, ureterovesical reimplantation, and temporary cutaneous ureterostomy.
- Follow-up ranged from 6 months to 20 years, assessing continence and infection resolution.
Main Results:
- Upper pole nephroureterectomy was performed in 16 patients with nonfunctioning renal segments; ureterovesical reimplantation in 10 with functioning segments.
- All patients presenting with incontinence achieved continence post-operatively.
- Ureterovesical reimplantation showed excellent results with no further procedures needed in 12 patients.
Conclusions:
- Conservative management of ectopic ureters in duplex systems with functioning renal segments is recommended.
- Surgical interventions like nephroureterectomy and ureterovesical reimplantation are effective in resolving symptoms.
- Preserving functioning renal segments in cases of ectopic ureters is a viable and successful strategy.
Abstract:
To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twenty-eight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twenty-four of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.