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Inter-ureteral anastomosis in the treatment of pathogenous ureteral duplications: indications, results (a series of 32 patients)

F. Benzaghou, S. Lortat-Jacob

Department of Pediatric Surgery and Urology, Necker - Enfants Malades Hospital, Paris, France

 

ABSTRACT

Objective: To evaluate the indications and results of ipsilateral uretero-ureteral anastomosis (UUA) as conservative treatment for pathogenic ureteral duplications with functional renal pelvis.

Material and methods: We made a retrospective study (1989-2008) of the files of children with pathological total unilateral ureteral duplication that were treated conservatively by ipsilateral UUA. The indications, surgical techniques and the results were extracted. Mean follow-up was 29 months (6-108 months)

Results: There were 32 children (24 girls and 8 boys) with pathological total unilateral ureteral duplication in which the function of the affected renal pelvis, as evaluated by scintigram or intravenous urography justified the indication for conservative treatment. 19 children (13/19 girls – Group 1) had a ureteral reflux towards the inferior pelvis and benefitted from termino-lateral anastomosis of the inferior pelvis (ip) ureter into the one of the superior pelvis (sp), (ip-sp UUA). 11 children (9/11 girls – Group 2) had a dilatation of the superior pelvis upstream from an ectopic extra-vesical ureteral termination and benefitted from a terminal-lateral anastomosis of the superior pelvis ureter into the one of the inferior pelvis (sp-ip UUA). 2 patients (Group 3) with reflux (ip) and ectopic ureter (sp) underwent uretero-vesical reimplantation associated to an ipsilateral UUA. There was no anastomotic fistula or ureteral stenosis. In the first group, cystography performed on 2 patients who had presented with one episode of secondary urinary infection with fever (1 and 3 months old) was normal. In the second group, the dilatation of the sp regressed and micturitional difficulties related to the ectopic ureter dissapeared.

Conclusion: Ipsilateral UUA is a reliable surgical technique for the conservative treatment of ectopic ureters or ureters with reflux, associated with pathological complete ureteral duplications.

 

Key words: ureteral duplication, functional kidney, inter-ureteral anastomosis