Uretère ectopique fonctionnel sur système urinaire double chez l’enfant : Intérêt de l’urétéro-urétérostomie basse à propos de 5 cas. Traitement conservateur des uretères ectopiques

Abstract

The objective of this study was to analyse the postoperative results of conservative management of functional ectopic ureter on duplicated collecting system by low uretero-ureterostomy in children. The medical records of children with duplicated collecting system and a functional ectopic ureter admitted to our department between 2001 and 2005 were reviewed. A postnatal radiological assessment comprising urinary tract ultrasound, retrograde cystography, intravenous urography and DMSA renal scintigraphy was performed. In each patient, the operative technique consisted of low uretero-ureterostomy with end-to-side uretero-ureteric anastomosis. This series comprised 3 girls and 2 boys. The ectopic ureter was located on the left side in all patients. Postnatal ultrasound confirmed the presence of dilatation of the upper collecting system and the retrovesical ureter estimated at 10 +/- 2 mm in 3 cases; in one case, dilatation of the upper collecting system was estimated at 25 mm and the retrovesical ureter was estimated at 16 +/- 2 mm; in the last patient, dilatation of the upper collecting system above the retrovesical ureter was estimated at 6.5 mm. Mean renal function of the upper pole (DMSA) was 23 +/- 7%. The mean age at the time of the operation was 8 months. The immediate postoperative course was uneventful in all patients. Mean follow-up was 38 months (range: 18 months to 4.5 years). All children were asymptomatic and a reduction of collecting system and ureteric dilatation was confirmed on follow-up ultrasound at 10 months in all patients. Low uretero-ureteric anastomosis is an alternative to high collecting system anastomosis or ureteric reimplantation in the presence of a functional ectopic ureter on duplicated collecting system in children.