Ureteroureterostomy via Inguinal Incision for Ectopic Ureters and Ureteroceles Without Ipsilateral Lower Pole Reflux

Abstract

We report outcomes from ureteroureterostomy performed through an inguinal herniorrhaphy type incision for definitive management of ectopic ureters or ureteroceles in the absence of ipsilateral lower pole reflux. Records were reviewed for 23 consecutive patients who underwent lower ureteroureterostomy for 26 duplicated systems with ectopic ureter or ureterocele and no ipsilateral lower pole reflux. In 21 patients surgery was performed through an inguinal incision similar to that for herniorrhaphy, while a Pfannenstiel incision was used initially in the series in 2 others with bilateral duplex systems. Median patient age at operation was 10 months (range 2 to 56). At a mean followup of 26 months preoperative upper pole hydronephrosis and distal upper ureteral dilatation had resolved or improved in all cases. Preliminary cutaneous ureterostomy was performed on 4 ureters (3 patients), 2 because the recipient lower pole ureter was thought to be too small for incision and anastomosis, 1 because of purulent drainage and 1 following inadvertent transection of the lower pole ureter. Mean surgical time for inguinal ureteroureterostomy was 101 minutes and mean postoperative hospitalization was 0.6 days. Except for dextranomer/hyaluronic acid injection in 1 patient with symptomatic grade I ipsilateral lower pole reflux, no additional surgical procedures were performed after ureteroureterostomy. Lower ureteroureterostomy offers potentially definitive treatment for ectopic ureter or ureterocele without ipsilateral lower pole reflux, and can be performed through an inguinal herniorrhaphy type incision.