Uretero-ureteral anastomosis (ureteropyeloanasto-mosis) for the duplicated upper urinary tract in children


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Abstract

Introduction. The duplex kidney is one of the most common congenital abnormalities of the urinary tract, and various surgical procedures exist for the management of this condition. Depending on the surgeon preferences, patients with duplex kidney may undergo heminephrectomy with ureterectomy using open or laparoscopic approach, uretero-cysto-anastomosis of the ectopic ureter or two ureters in a single block. Recently, there have been reports of inter-ureter anastomoses. Here we report our multicenter experience in open and laparoscopic uretero-ureteral anastomosis (UUA). The study aimed to improve the treatment results in children with urodynamic dysfunction due to the duplicated upper urinary tract. Materials and methods. We retrospectively analyzed medical records of 64 children treated from 2007 to 2017. There were 22 (32.8%) boys and 43 (67.2%) girls with mean age 40.2 months at the time of surgery. All of them had duplex kidneys, including 27 (42.2%) right-sided and 37 (57.8%) left-sided. Of them, 15 (23.4%) children underwent distal UUA (DUAA), and 49 (76.6%) had proximal UUA (PUUA). Results. After surgery, acute pyelonephritis occurred in three patients. In the early postoperative period, a prolonged urinary leakage from surgical site drainage was observed in three (6.1%) patients after laparoscopic PUUA. One (4.2%) child developed a stumpitis. Thus, complications occurred in 7 (10.9%) children; one of them (1.6%) needed additional treatment. Conclusion. Distal and proximal UUA is a safe and effective surgical treatment for urinary outflow disorders in patients with the duplicated upper urinary tract, minimizing the risk of the duplex kidney dysfunction.

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About the authors

I. M Kagantsov

Republican Children’s Clinical Hospital, Syktyvkar; Pitirim Sorokin Syktyvkar State University

Email: ilkagan@rambler.ru
Dr.Med.Sci., Professor at the Department of Surgical Diseases; Head of Department of Urology

V. V Sizonov

RostSMU of Minzdrav of Russia

Email: vsizonov@mail.ru
Dr.Med.Sci., Professor

V. I Dubrov

Children’s Hospital №2, Minsk

Email: dubroff2000@mail.ru
Ph.D. Head of the Department of Urology

S. G Bondarenko

Clinical Emergency №7, Volgograd

Email: sergebondarenko@rambler.ru
Ph.D. Head of the Department of Urology

N. R Akramov

Kazan State Medical University of Minzdrav of Russia

Email: aknail@rambler.ru
Dr.Med.Sci., Professor at the Department of Pediatric Surgery

O. S Shmyrov

Morozovskaya Children’s City Clinical Hospital

Email: moroz-uro@mail.ru
Ph.D., Head of the Department of Urology

G. I Kuzovleva

Children’s City Clinical Hospital No. 9, Moscow

Email: dr.gala@mail.ru
Ph.D.

R. V Surov

Regional Children’s Clinical Hospital, Kemerovo

Email: rimvs@mail.ru
Pediatric Urologist-Andrologist

A. A Logval’

Cherepovets Children’s City Hospital

Email: alex.logval@yandex.ru

References

  1. Nation E.F. Duplication of the kidney and ureter: a statistical study of 230 new cases. J. Urol. 1944;51:456.
  2. Campbell M.F., Harrison J.H. Anomalies of the ureter. Urology. 3rded. 1970 WB Saunders Philadelphia. 1970;1487-1670.
  3. Каганцов И.М., Сизонов В.В., Дубров В.И., Бондаренко С.Г., Акрамов Н.Р., Шмыров О.С., Кузовлева Г.И., Марков Н.В., Саблин Д.Е., Суров Р.В., Пирогов А.В., Логваль А.А. Лапароскопическая геминефруретерэктомия при удвоенной почке у детей. Урология. 2017;5:63-68
  4. Mackie G.G., Stephens F.D. Duplex kidneys: A correlation of renal dysplasia with position of the ureteral orifice. J. Urol. 1975; 114: 274-280.
  5. Belman A.B., Filmer R.B., King L.R. Surgical management of duplication of the collecting system. J. Urol. 1974;112:316-321.
  6. Rickwood A.M., Reiner I., Jones M., Pournaras C. Current management of duplex-system ureteroceles: Experience with 41 patients. Br J. Urol. 1992;70:196-200.
  7. Husmann D.A. Renal dysplasia: The risks and consequences of leaving dysplastic tissue in situ. Urology. 1998;52:533-536.
  8. McLeod D.J., Alpert S.A., Ural Z., Jayanthi V.R. Ureteroureterostomy irrespective of ureteral size or upper pole function: A single center experience. J. Pediatr Urol. 2014;10(4):616-619.
  9. Lee N.G., Corbett S.T., Cobb K., Bailey G.C., Burns A.S., Peters C.A. Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population. J. Endourol. 2015;29(11):1237-41. doi: 10.1089/end.2015.0223.
  10. Biles M.J., Finkelstein J.B., Silva M.V., Lambert S.M., Casale P. Innovation in Robotics and Pediatric Urology: Robotic Ureteroureterostomy for Duplex Systems with Ureteral Ectopia. J. Endourol. 2016;30(10):1041-1048.
  11. Wong Y.S., Tam Y.H., Pang K.K. A case report of laparoscopic ipsilateral ureteroureterostomy in children with renal duplex. Research and Reportsin Urology. 2016;26:35-39.
  12. Chacko J.K., Koyle M.A., Mingin G.C., Furness P.D., 3rd Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication. J. Urol. 2007;178:1689-1692.
  13. Lashley D.B., McAleer I.M., Kaplan G.W. Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication. J. Urol. 2001;165:552-554.
  14. Steyaert H., Lauron J., Merrot T., Leculee R., Valla J.S. Functional ectopic ureter in case of ureteric duplication in children: Initial experience withlaparoscopiclow transperitonealureteroureterostomy. J. Laparoendosc Adv Surg Tech A. 2009;19(Suppl. 1):S245-247.
  15. Storm D.W., Modi A., Jayanthi V.R. Laparoscopic ipsilateral ureteroureterostomy in the management of ureteral ectopia in infants and children. J. Pediatr Urol. 2011;7:529-533.
  16. Chandrasekharam V.V.S., Jayaram H. Laparoscopic ipsilateral ureteroureterostomy for the management of children with duplication anomalies. J Indian Assoc Pediatr Surg. 2015;20(1): 27-31. doi: 10.4103/0971-9261.145442.
  17. Kim K.S., Kim Y., Oh S.J. Natural history of refluxing distal ureteral stumps following upper tract surgery in children with ectopic ureter or ureterocele. Urol Int. 2001;67:142-146.
  18. Agarwal D., Kandpal D.K., Chowdhary S.K. J Indian Assoc Pediatr Surg. 2016;21(2):92-93. doi: 10.4103/0971-9261.158094/
  19. De Caluwe D., Chertin B., Puri P. Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys. J Urol. 2002;168:679-680.
  20. Ade-Ajayi N., Wilcox D.T., Duffy P.G., Ransley P.G. Upper pole heminephrectomy: Is complete ureterectomy necessary? BJU Int. 2001;88:77-79.
  21. Michaud J.E., Akhavan A. Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters. Curr. Urol. Rep. 2017;18:21 doi: 10.1007/s11934-017-0664-0.

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