Ipsilateral Pyeloureterostomy for Managing Lower Pole Reflux with Associated Ureteropelvic Junction Obstruction in Duplex Systems

Abstract

In duplex renal systems with a normal upper pole collecting system, and a lower pole collecting system with reflux and ureteropelvic junction obstruction or a kink at the ureteropelvic junction (that is reflux with trapping), treatment must address reflux and obstruction. We reviewed the results of ipsilateral pyeloureterostomy as a single corrective procedure. We retrospectively reviewed our experience with 10 children who had complete ureteral duplication with lower pole reflux (grades III to V) and associated lower pole ureteropelvic junction obstruction or a ureteral kink with trapping. All patients were treated with ipsilateral end-to-side pyeloureterostomy. Followup ranged from 1 to 14 years. All patients had a good postoperative result, there have been no immediate or long-term complications and no subsequent surgical procedure was needed. All patients had continued lower pole renal growth with good function, 9 had resolution or a marked decrease in pelvicaliceal dilatation and none had evidence of obstruction. Ipsilateral end-to-side pyeloureterostomy for treating reflux into the lower moiety of a duplicated collecting system with associated ureteropelvic junction obstruction or a kink appears to be a single, safe corrective procedure that simultaneously manages vesicoureteral reflux and relieves the proximal obstructive process.