Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication

PURPOSE: We reviewed our experience with ureteroureterostomy as definitive treatment for vesicoureteral reflux or obstruction associated with ureteral duplication to determine the efficacy and morbidity of this procedure and identify factors that affect outcome. MATERIALS AND METHODS: We performed a total of 100 ureteroureterostomies in 94 children with an average age of 28 months during the 23-year period ending May 1999. Four patients (4 kidneys) failed to return for postoperative evaluation. Followup was 2.5 to 206 months (mean 33). Indications for surgery were vesicoureteral reflux in 53 cases, obstructing ureterocele in 19, ureterocele with upper pole reflux in 4, an ectopic obstructed upper pole ureter in 18 and other in 2. In 23 kidneys ureteroureterostomy was combined with reimplantation of the recipient ureter. Surgery was considered successful when postoperative imaging revealed no reflux or obstruction and a patent ureteroureterostomy anastomosis. RESULTS: Ureteroureterostomy with or without ureteroneocystostomy was successful for treating 94% of kidneys, including 51 of 53 with reflux, 21 of 23 (91%) with ureterocele and 17 of 18 (94%) with an ectopic obstructed upper pole ureter. Significant ureteral size disparity, defined as a donor ureter diameter greater than 2-fold that of the recipient ureter, was noted in 69 kidneys. The most common complication (13 patients) was prolonged output from the Penrose drain. However, this complication did not result in a failed procedure in any case. CONCLUSIONS: Ipsilateral ureteroureterostomy is safe and efficacious for treating abnormalities associated with ureteral duplication. A significant discrepancy in ureteral size does not preclude ureteroureterostomy.     

Ureteroureterostomy in complete ureteral duplication.

Homolateral pelvic ureteroureterostomies were performed in 25 patients presenting with complete duplication of the pyeloureteric tract. The procedure was performed in 16 cases of ureteroceles, in 7 cases of reflux in duplicated ureters, in 1 case of ectopic ureter and in 1 postoperative stenosis of one segment of a double ureter. According to the authors' experience this is the surgical treatment of choice in conservative surgical treatment.     

Uncrossed complete ureteral duplication with upper system reflux

We report a case of uncrossed complete ureteral duplication with the orifice of the upper system ureter opening in the cranial and lateral position in the bladder. There was reflux only to the upper system of the duplex kidney, and the patient was treated successfully by conjoint reimplantation of the double ureters.     

Ipsilateral ureteroureterostomy for single ureteral disease in patients with ureteral duplication: a review of 8 years of experience with 16 patients

Ipsilateral ureteroureterostomy near the bladder (end-to-side anastomosis) for treatment of single ureteral disease in patients with complete ureteral duplication has been performed in 16 patients during the last 8 years. The operative technique, indications, results, followup and complications are presented. Reflux in the lower segment ureter was treated in 13 patients and upper segment ectopia or ureterocele was managed in 3 patients with this operative procedure. This operative technique is simpler and safer than reimplantation of both ureters into the bladder. Because no dissection of the bladder wall is needed there is less risk of injury to the pelvic viscera and vasculature. The chance of success in correcting reflux appears better than with reimplantation of both ureters into the bladder. Long-term followup has shown few complications and no repeat operations were needed in this series. The small stump of the diseased ureter left behind near the bladder caused no serious problems.     

Sotos syndrome associated with complete ureteral duplication and bilateral vesicoureteral reflux

A 4-year-old boy with Sotos syndrome had repeated urinary tract infections. Complete right ureteral duplication and bilateral vesicoureteral reflux were, diagnosed, and anti-reflux surgery was performed. This child also had elevated serum creatine kinase levels and atypical absence seizures. The associations of ureteral duplication, continuously elevated serum creatine kinase level, and atypical absence seizure have not been reported previously in Sotos syndrome. Received: March 1, 2001 / Accepted: June 18, 2001     

Trans-uretero-ureterostomy with a blind-ending ureteral duplication

International Urology and Nephrology -     

Repeat knot formation in a patient with an indwelling ureteral stent

A patient treated for nephrolithiasis formed knots in 2 occasions, in 2 separate indwelling ureteral stents. This rare complication may make stent removal difficult. To our knowledge, this is the first case report of repeat knot formation in a single patient.     

Laparoscopic ureteroureterostomy in children with a duplex collecting system plus obstructed ureteral ectopia

One of the complex upper urinary tract anomalies is a duplicated collecting system. In cases with a functioning upper moiety, ureteroureterostomy (UU) is the preferred operation to redirect the urine to the normal collecting system. Although open UU is a well-described operation, experience with laparoscopic repair pediatric patients is scarce. We describe the successful application of laparoscopic UU in 2 children and suggest that laparoscopic UU for the duplicated collecting system is a promising minimally invasive procedure.     

Hand-assisted laparoscopic ureteroureterostomy with renal mobilization for delayed recognition of a proximal ureteral injury after lumbar disk surgery

We present hand-assisted laparoscopic ureteroureterostomy (HALUU) with renal mobilization as a novel approach to the management of proximal ureteral injury after lumbar disk surgery. A 63-year-old female underwent L4-L5 diskectomy and facetectomy with cage placement for back and leg pain. Postoperatively, she developed fever, nausea, abdominal pain, ileus and leukocytosis. A computed tomography scan of the abdomen and pelvis with intravenous contrast and delayed imaging demonstrated a left proximal ureteral injury with contrast extravasation. Retrograde and antegrade ureteral stent placement was unsuccessful; a nephrostomy tube was placed. Antegrade and retrograde ureterograms revealed a 3-cm proximal ureteral defect. All treatment options were discussed, and the patient chose to undergo hand-assisted laparoscopic renal mobilization with ureteroureterostomy, which was completed successfully without complications. Operative time was 381 minutes; estimated blood loss was 50 mL. The patient was discharged after 2 days, her ureteral stent was removed in 8 weeks, and follow-up with furosemide-mercaptoacetyltriglycine (MAG-3) renal scan demonstrated 30% function without evidence of obstruction. Hand-assisted laparoscopic ureteroureterostomy with renal mobilization can be performed as definitive management of a medium-length proximal ureteral injury. This is the first case describing this management technique after lumbar disk surgery.     

Giant ureteral stone associated with partial ureteral duplication

We are presenting a 36-year-old male patient with right flank pain and a history of recurrent urinary tract infection for three years. Radiographic intervention revealed a right partial ureteral duplication with a giant stone in size 9.6 cm in the ureteral limb draining the non-functioning upper pole of the right kidney. Open ureterolithotomy and partial nephroureterectomy was performed by a right flank incision. The presence of a ureteral partial duplication created a "yo-yo phenomenon", which interfered with stone passage to the bladder and may cause such giant ureteral stone.     

Ureteropelvic junction obstruction of the upper pole moiety in complete ureteral duplication

Ureteropelvic junction obstruction of the upper pole moiety is reported in 2 patients with complete ureteral duplication. A normal upper pole ureter of a duplicated system in conjunction with upper pole dilatation should alert the urologist to the presence of an upper pole ureteropelvic junction obstruction. Traditional pyeloplasty techniques can be applied to this anomaly with successful salvage of renal parenchyma. The embryological implications of this combination of anomalies occurring in a single patient are discussed briefly.     

A case of primary ureteral carcinoma in association with unilateral complete duplication of the ureter

We are presenting a 68-year-old female patient who was diagnosed to have a complete ureteral duplication and adenocarcinoma in the ureter which drained the upper moiety of the right kidney.     

Hair as nidus for ureteral calculus formation: case report

A 52-year-old man with a significant history of nephrolithiasis was found to have a calcium oxalate dihydrate ureteral calculus that apparently formed on a hair. This nidus may have been introduced during previous instrumentation, perhaps on the tip of the ureteroscope, laser fiber, or even during the placement of a ureteral stent.     

Solitary kidney with blind-ending ureteral duplication

The first case of blind-ending ureteral duplication with contralateral renal agenesis is presented. Ureteroureteral reflux due to asynchronous peristaltic activity is presumed to be responsible for functional obstruction and recurrent infection. Surgical intervention offered cure. Relevant literature is reviewed.