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J Urol. 2017 Nov;198(5):1159-1167. doi: 10.1016/j.juro.2017.05.078. Epub 2017 May 29.

Side-to-Side Refluxing Nondismembered Ureterocystotomy: A Novel Strategy to Address Obstructed Megaureters in Children.

Author information

1
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
2
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
3
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Urology, University of Kansas Medical Center and Children's Mercy Hospital, Kansas City, Kansas.
4
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Urology, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee.
5
Division of Urology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
6
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: armando.lorenzo@sickkids.ca.

Abstract

PURPOSE:

A nonrefluxing megaureter is a relatively common cause of antenatal hydronephrosis. Although nonoperative management is favored, surgical intervention is sometimes warranted. However, there is controversy regarding the best approach, particularly in young children. We describe our experience with nondismembered side-to-side refluxing ureterocystotomy as a simple option to address obstruction.

MATERIALS AND METHODS:

Between January 2012 and January 2017, 32 patients underwent ureterocystotomy at 4 referral centers in North America. Demographics, surgical indications, complications, need for further interventions and change in hydronephrosis were captured. Patients were monitored clinically and with serial ultrasounds.

RESULTS:

Mean age at surgery was 3.7 months (range 0 to 33) and 25 (78%) patients were male. Unilateral procedures were performed in 29 patients. All patients were initially identified based on the presence of antenatal hydronephrosis and symptoms developed in 10. The procedure was conducted for primary nonrefluxing megaureter in 27 patients and to address secondary obstruction in the remainder. Mean followup was 34.3 months (range 6 to 58). At the most recent evaluation most children demonstrated significant improvement in dilation (86%). To date, 6 patients have undergone further procedures, including a circumcision and 2 ureteral reimplantations for recurrent infections.

CONCLUSIONS:

Our results suggest that side-to-side refluxing ureterocystotomy is a straightforward, minimally invasive alternative for the surgical management of nonrefluxing megaureter. Despite the trade-off of relieving obstruction and creating reflux, it can be considered a potentially definitive procedure in patients who remain infection-free, particularly circumcised boys. Extended followup with close monitoring is critical to document long-term results with this intervention.

KEYWORDS:

hydronephrosis; pediatrics; ureter; vesico-ureteral reflux

PMID:
28571679
DOI:
10.1016/j.juro.2017.05.078
[Indexed for MEDLINE]

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