Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication |
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| Authors: | Brian A VanderBrink Mark P Cain David Gilley Kirstan K Meldrum Richard C Rink |
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| Institution: | 1. Department of Biomedical Sciences, Metabolism and Neuroscience, University of Modena and Reggio Emilia, NOCSE Hospital, Modena, Italy;2. Department di Neuroscience, University of Parma, Parma, Italy;3. Epilepsy Centre, San Paolo Hospital, Health Science Department, University of Milano, Italy;4. Department of Life and Reproduction Sciences, University of Verona, Verona, Italy;5. Pediatric Neurology Unit, V. Buzzi Hospital, A.O. ICP, Milano, Italy;6. Department of Medicine, Surgery and Dentistry, Faculty of Medicine and Surgery, University of Milano, Milano, Italy;1. Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;2. Department of Urology, Fukushima Medical University, Fukushima, Japan;1. Department of Paediatric Urology, Royal Manchester Children''s Hospital, Oxford Road, Manchester, M13 9WL, UK;2. Department of Paediatric Urology, Leeds General Infirmary, Leeds, LS1 3EX, UK |
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| Abstract: | IntroductionThe lower moiety of duplex kidney can be associated with ureteropelvic junction obstruction (UPJO). Surgical correction can be challenging in cases of incomplete duplication where the junction of the lower and upper pole ureters is proximal. We review our experience with this unusual entity with an emphasis on surgical techniques employed in reconstruction.MethodsWe retrospectively reviewed the charts of eight patients with lower pole UPJO who underwent surgery in 2002–2008. The surgical approach, specifically the utilization of the non-obstructed upper pole ureter, used in the reconstruction was noted.ResultsFour of eight patients were symptomatic at presentation with either infection or pain. UPJO was at least in part secondary to lower pole crossing vessels in four patients and was treated with dismembered pyeloplasty. Lower pole to upper pole pyeloureterostomy was necessary in four patients due to short ureteral length between the UPJ and junction of lower and upper pole ureters. No complications or obstruction of either moiety developed during 1 year of follow up.ConclusionsLower pole UPJO in incomplete renal duplication mandates individualized surgical treatment dependent upon anatomy encountered. We have found that pyeloureterostomy is a safe alternative to drainage of the obstructed lower pole. |
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