Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication.

PURPOSE: Ipsilateral ureteroureterostomy for the surgical management of severely dilated ureter in ureteral duplication is well supported in the surgical literature but often not done. We evaluated our institutional experience with ureteroureterostomy in duplication anomalies to assess the feasibility and success of this procedure.

MATERIALS AND METHODS: An 8-year retrospective review of the records of all patients with complete renal duplex anomalies was evaluated. Anatomical presentations, and operative and nonoperative treatment of these patients were evaluated.

RESULTS: A total of 193 patients were identified with complete renal duplication. Associated anomalies included ureterocele in 24 patients, ectopic ureter in 38 and vesicoureteral reflux in 57. Of 193 patients 160 (83%) with duplex anomalies underwent surgical intervention with a total of 41 ureteroureterostomies performed in 39 patients with dilated donor ureters. A total of 11 ureteroureterostomies were performed primarily and 30 were performed in conjunction with ipsilateral ureteral reimplantation of the distal common segment below the ureteroureterostomy. Ten of the 39 patients had the contralateral side reimplanted for vesicoureteral reflux. In all children with ureteroureterostomy the anastomosis between the 2 ureters remained patent. Two of the 11 children who underwent ureteroureterostomy alone had de novo ipsilateral vesicoureteral reflux (1), which was treated with ureteral reimplantation, and subureteral injection (1). Two children who underwent concomitant ureteroureterostomy and reimplantation without indwelling stents had transient postoperative urinomas that required subsequent drainage. Additionally, 3 patients had persistent ipsilateral vesicoureteral reflux, which was treated with subureteral injection in 1 and observation in 2. One patient presented with transient ipsilateral urinary obstruction, which required percutaneous drainage and resolved spontaneously.

CONCLUSIONS: In cases of ureteral duplication with a severely dilated ureter requiring surgical intervention ipsilateral ureteroureterostomy is a viable option for reflux and/or obstruction. The procedure is rapid and technically feasible, and it offers excellent cosmesis. In addition, ureteroureterostomy has minimal morbidity and it facilitates early hospital discharge.