Ureterocalicostomy in children: 12 years experience in a single centre

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Since 1947 ureterocalicostomy has been a recognised option in the treatment of obstructive systems either as a primary or salvage procedure, however few series specific to the paediatric patient exist. This 12 year review of 13 cases at one tertiary centre demonstrates ureterocalicostomy to be a versatile, reliable means of relieving obstruction for a variety of indications; horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy.

OBJECTIVE

• ? To document the outcome of ureterocalicostomy in children.

PATIENTS AND METHODS

• ? The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively.
• ? Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi‐ureteric junction (PUJ) obstruction.
• ? In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty.
• ? An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically‐assisted technique.

RESULTS

• ? Mean age at operation was 9.3 years and the mean (range) duration of follow‐up was 2.6 (0.3–7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging.
• ? However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow‐up to 3 years.

CONCLUSIONS

• ? Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy.
• ? Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.