Application of upper or lower pole ureter dismembered extravesical reimplantation in children with complete duplex kidney

Abstract

Objective To explore the efficacy of upper or lower pole ureter dismembered extravesical reimplantation in the treatment of complete duplicated collecting systems. Methods Between December 2009 and December 2014, 27 cases of complete duplex kidney were operated by upper or lower pole ureter dismembered extravesical reimplantation. There were 19 girls and 8 boys with an average operative age of 25.2 (2-96) months. All of them were diagnosed as complete duplication anomalies with single ureteral pathological changes by preoperative iconography. There were ectopic ureter (n=9), ureteroceles (n=10) and lower pole vesicoureteral reflux (n=8). The major clinical symptoms included urinary dripping, fever and urinary tract infection. The postoperative follow-up period was 11-72 months. Renal sonography, excretory urography, radionuclide scanning and voiding cystourethrography were performed. Results All operations were successful. The average operative duration was 63 minutes and mean length of hospital stay 5 days. And 27 cases had a resolution of preoperative symptoms disappeared after operation. One case of postoperative hematuria due to ureteral calculus in ureter bladder anastomosis was managed by holmium laser lithotripsy through cystoscopy. After operation, all renal functions improved or stabilized. Postoperative follow-up voiding cystourethrogram showed no vescoureteral reflux in 7 cases. Conclusions Inguinal approach to upper or lower pole ureter dismembered extravesical reimplantation is safe, efficacious and well-tolerated for children with duplicated collecting systems. And it is worthy of wider popularization. Key words: Duplex kidney; Deformity of kidney; Ureteral reimplantation