Laparoscopic ureteroureterostomy for the treatment of complete duplicated systems with hydronephrosis and ureteral dilation in children

Abstract

Objective To discuss the efficacy of laparoscopic ureteroureterostomy for upper pole hydronephrosis and ureteral dilatation in children with complete duplex kidney. Methods The clinical data of 14 patients (15 units in total) who underwent laparoscopic ureteroureterostomy from April 2016 to October 2017 were retrospectively analyzed.Nine out of 14 cases had repeated urinary tract infections(UTI) and other symptoms[6 cases in group A: patients without vesicoureteral reflux(VUR) but presenting urinary tract infection (UTI) symptoms, 3 cases in group C: patients diagnosed with VUR]; 5 cases of asymptomatic patients were selected as group B. All the 14 cases had upper pole hydronephrosis and ureteral dilatation.Preoperative examinations included ultrosonograpy, urinary magnetic resonance urography(MRU), intravenous pyelography (IVP), voiding cystourethrogram(VCUG), and nuclear renal scanning.It was found that 4 cases had ureterocele; 3 cases had recurrent cystoureteral reflux (group C) before operation, and 1 case had cystoureteral refluxed after replantation. Results Laparoscopic surgery was successful in all of 14 children.None of them were shifted to open surgery because of abdominal viscera injury bleeding.The operation duration was 85-140 min.The average posto-perative hospital stay was 5.58 days.There was neither urinary anastomotic leakage nor UTI.Fourteen cases were followed up and the postoperative follow-up period was 7-23 months.No cases developed urinary tract infection except 2 cases with vescioureteral reflux.Ultrasound examination showed that the upper renal parenchyma of 5 children was thicker, ultrasonography showed that upper pole hydronephrosis was better and ureteroceles were smaller.There was no complication such as lower pole hydronephrosis.The symptoms of urinary tract infection disappeared after operation. Conclusions Laparoscopic ureteroureterostomy can treat renal duplication with less trauma, and it is safe and effective.It can be one of therapeutic regimen to treat low-functional upper pole hydronephrosis and ureteral dilatation in renal duplication.Howe-ver, this procedure cannot be used for vescoureteral reflux cases because of high rate of stump infection. Key words: Child; Complete duplex kidney; Laparoscope; Ureteroureterostomy