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J Pediatr Urol. 2019 May;15(3):284-285. doi: 10.1016/j.jpurol.2019.03.005. Epub 2019 Mar 14.

Ureteral clipping for the treatment of a non-functioning upper kidney moiety associated with a massive ureterocele: step-by-step description of a novel technique.

Author information

1
The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; University of Sao Paulo Medical School, Department of Urology, Pediatric Urology Unit, Av. Dr. Eneas Carvalho de Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil.
2
University of Sao Paulo Medical School, Department of Urology, Pediatric Urology Unit, Av. Dr. Eneas Carvalho de Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil. Electronic address: marcos.urologia@gmail.com.
3
The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

Abstract

OBJECTIVE:

The objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys.

MATERIALS AND METHODS:

In this video, one case is presented to demonstrate this novel technique. A nine-year-old boy presented with progressive lower urinary tract symptoms. Radiological workup depicted a duplex kidney on the left side with the absence of function on the upper pole and hydroureteronephrosis with a massive ureterocele. Laparoscopic ureteral transection, drainage, and ligation of both extremities of the enlarged ureter (upper pole ureter) were performed.

RESULTS:

Immediately after ureteral ligation, ultrasonic evidence of ureterocele decompression and improved hydroureteronephrosis was observed. This patient remained asymptomatic without postoperative complications after 3 years. De novo reflux was not observed.

CONCLUSION:

Ureteral ligation, as demonstrated in the video, is a good approach for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. Compared with the current standard techniques (incision/puncture), ureteral ligation has the clear advantage of not causing 'de novo reflux' or unsuccessful de-obstruction, and is not as surgically demanding as other reconstructive/ablative techniques. The disadvantage is the need of regular clinical and ultrasonographic follow-up.

KEYWORDS:

Duplex kidneys; Laparoscopy; Pediatric; Ureteral clipping; Ureterocele

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