Laparoscopic ureteroureterostomy for the treatment of complete duplicated systems with hydronephrosis and ureteral dilation in children / 中华实用儿科临床杂志

Objective To discuss the efficacy of laparoscopic ureteroureterostomy for upper pole hydronephro-sis and ureteral dilatation in children with complete duplex kidney.Methods The clinical data of 14 patients (15 units in total)who underwent laparoscopic ureteroureterostomy from April 2016 to October 2017 were retrospectively analyzed. Nine out of 14 cases had repeated urinary tract infections(UTI)and other symptoms[6 cases in group A:patients without vesicoureteral reflux(VUR)but presenting urinary tract infection (UTI)symptoms,3 cases in group C:patients diagnosed with VUR];5 cases of asymptomatic patients were selected as group B.All the 14 cases had upper pole hydronephrosis and ureteral dilatation.Preoperative examinations included ultrosonograpy,urinary magnetic resonance urography(MRU), intravenous pyelography (IVP),voiding cystourethrogram(VCUG),and nuclear renal scanning.It was found that 4 cases had ureterocele;3 cases had recurrent cystoureteral reflux (group C)before operation,and 1 case had cystoureteral re-fluxed after replantation.Results Laparoscopic surgery was successful in all of 14 children.None of them were shifted to open surgery because of abdominal viscera injury bleeding.The operation duration was 85－140 min.The average posto-perative hospital stay was 5.58 days.There was neither urinary anastomotic leakage nor UTI.Fourteen cases were followed up and the postoperative follow－up period was 7－23 months.No cases developed urinary tract infection except 2 cases with vescioureteral reflux.Ultrasound examination showed that the upper renal parenchyma of 5 children was thicker,ul-trasonography showed that upper pole hydronephrosis was better and ureteroceles were smaller.There was no complication such as lower pole hydronephrosis.The symptoms of urinary tract infection disappeared after operation.Conclusions Laparoscopic ureteroureterostomy can treat renal duplication with less trauma,and it is safe and effective.It can be one of therapeutic regimen to treat low－functional upper pole hydronephrosis and ureteral dilatation in renal duplication.Howe-ver,this procedure cannot be used for vescoureteral reflux cases because of high rate of stump infection.

Cirugía conservadora de anomalías asociadas a la duplicación ureteral: 40 años de experiencia / Conservative surgery of anomalies associated to the ureteral duplication: 40 years of experience

Objetivo: Exponer la experiencia del Servicio de Urología del Hospital Provincial Pediátrico, el tratamiento de las anomalías asociadas a la duplicidad ureteral. Métodos: Se hizo una revisión retrospectiva de 378 pacientes con duplicación ureteral, entre 1970 al 2010; se realizó tratamiento quirúrgico conservador a 26 casos y 6 casos de ellos tenían edad pediátrica, los cuales son objeto de análisis en este trabajo, según datos obtenidos en el registro de documentación médica de los centros. De los seis casos operados, a cinco se les realizó cirugía conservadora (uréteropielóstomia), y en un caso se realizó nefrectomía polar superior. Resultados: La duplicidad ureteral es una patología frecuente, determina un estasis urinario. El uréter bífido extra vesical, provoca reflujo urétero-ureteral. Conclusiones: Esta técnica quirúrgica es útil en las en las anomalías asociadas a la duplicidad ureteral. No se debe utilizar ésta cuando no haya posibilidades de conservación de parénquima renal.

Objective: To expose the experience of the Urology Service of the Teaching Pediatric Provincial Hospital, in the treatment of the anomalies associated with the ureteral duplication. Methods: We retrospectively reviewed the medical records of 378 patients with Ureteral Duplication attended in our center in the period 1970-2010; the surgical treatment was applied in 26 cases, and 6 of them were pediatric cases; the last ones are analyzed in this work, taking into account data obtained from the Clinical Documentation Database of the centers involved. The conservative surgery (uretero-pyelostomy) was carried out in 5 patients of the 6 cases and in the other 1 case, an upper pole we made upper pole nephrectomy. Results: The ureteral duplication is a frequent pathology that determines a urinary stasis. The extra-vesical bifid ureter causes uretero-ureteral reflux. Conclusions: This surgical procedure is useful in the anomalies associated with the ureteral duplication. It should not be used when there are not possibilities of conserving the renal parenchyma.

Successful treatment of vesicoureteral reflux by ureteroureterostomy in renal transplant recipients / 대한내과학회지

Recurrent urinary tract infection due to vesicoureteral reflux is one of the important medical complications in renal transplant recipients. Injection of macroplastique is recommended to reduce the vesicoureteral reflux, but it can result in poor responses. Ureteroureterostomy is an invasive method, but it is advisable in patients with higher grades of vesicoureteral reflux that do not respond to medical or macroplastique injection. We here report on two cases of successful treatment of vesicoureteral reflux by ureteroureterostomy. These patients experienced repeated episodes of acute pyelonephritis in spite of long-term antibiotic treatment and repeated macroplastique injection. No more urinary tract infection was observed after ureteroureterostomy. We recommend ureteroureterostomy in renal transplant recipients who suffer with repeated acute pyelonephritis due to vesicoureteral refulx.

Ureteroureterostomy after Ureteroneocystostomy Complications in Renal Transplantation / 대한이식학회지

PURPOSE: At present renal transplantation, the most frequent surgical complications may be occurred on ureterovesical anastomosis site (i.e. leakage, stenosis and reflux). The results of ureteroureterostomy using recipient's own ureter in these complications, will be presented. METHODS: From 1983 to 2004, 410 renal transplantations were performed at our institution. In all cases, external ureteroneocystostomy technique was used. Complications involving the anastomosis site occurred in 23 cases (5.4%), with 15 stenosis (3.4%) and 8 cases of leakage (1.9%). All of them were living donor cases. The mean recipient's age was 47.2 years. Corrective surgery were performed as soon as complication confirmed radiologically (ultrasonography), 16.1+/-22.3 days after transplantaion for leakage and 86.8+/-87.6 days for stenosis. If the length of graft ureter was long enough, ureteroneocys tostomy was performed again and if not, end to side ureteroureterostomy was performed in 12 cases, end to end ureteroureterostomy in 1 case and end to end pyeloureterostomy in one case. A double J ureteral stent was used in every case. RESULTS: There were one graft loss due to stone formation nephropathy, one mortality due to herpetic infection with functioning graft and one failure of recovery of graft function because of too late patients visit. Others had good graft function until last follow up with 3.8+/-2.5years of mean follow-up without further ureteral complications. CONCLUSION: Ureteroureterostomy is a safe and permanent treatment for complications of ureterovesical anastomosis site and gives good results.

Clinical Features and Management in Patients with Prenatally Detected Duplex System Ureteroceles / 대한비뇨기과학회지

PURPOSE: Prenatal sonography resulted in increased recognition of renal duplication anomalies and, therefore, earlier urological referral and evaluation. However, surgical approach in very young children is debating. We attempt to investigate clinical features and to propose the management strategies in patients with prenatally detected ureteroceles. MATERIALS AND METHODS: From 1982 to 1997, there has been 35 patients (47 units) of duplex system ureter in which both preoperative and postoperative imaging studies including DMSA renal scan were available. Among these, detailed diagnosis and treatment of prenatally detected (PreD) ureteroceles associated with duplex system (9 patients or 12 ureteroceles) were assessed compared with post-natally detected (PND) ones (26 patients or 35 ureteroceles). RESULTS: There were 2 males and 7 female patients in PreD group, whose ureteroceles presented as 6 unilateral (right 1, left 5) and 3 bilateral units. There were 3 patients (33%) presented with urinary tract infection in PreD group and 24 patients (92%) in PND group. Functional evaluation by DMSA renal scan revealed that 8 units (67%) were functioning in PreD group while 37% in PND group, which was not significantly different between two groups. Initial treatment in PreD group were performed in 11 units; transurethral ureterocele incision (TUI, 8 units), ureteroureterostomy (UUO, 1) and upper pole nephrectomy (UPNx, 2). Additional surgery was performed in 8 units, all of which were initially performed TUI. When initial functional status of the upper pole (UP) determined by renal scan were analyzed by ultimate mode of treatment, initially nonfunctioning parenchyme resulted in UPNx in 4 units and 8 functioning moiety were led to parenchyme-sparing surgery, implying TUI actually had not modified ultimate clinical course. Taken both PreD and PND together, UUO and ureteral reimplantation showed lower secondary operation rate. CONCLUSIONS: Although statistics did not fully support our clinical impression, patients with PreD ureterocele have higher proportion in preserving UP function compared with that of a PND. Our results shows direct approach to the upper pole according to the functional status is preferred.

Ureteroureterostomy for the Management of Iatrogenic Lower Ureter Injury / 대한비뇨기과학회지

Ten cases of lower ureteral injuries resulting from pelvic surgery, all females with an average age of 48.8 years. were treated by a end-to-end ureteroureterostomy at the Seoul National University Hospital between January 1987 and December 1993, Of the patients nine were from gynecologic surgery and one was from general surgery. Only one case was detected intraoperatively and the others were referred post-operatively. A watertight, tensionless, spatulated anastomosis with double J stenting was performed to all as soon as the diagnosis was made. In one patient renal mobilization was necessary because of the long ureteral defect. The mean length of the resected sections of the ureter and the distal ureteral stumps were 26 mm and 27 mm, respectively. The mean duration of followup was 3 years. Good results with no morbidity were achieved in all. Our results suggest that ureteroureterostomy is a good operative method having great success rate in the treatment of lower ureter injury. And it thought be a good alternative to Boari flap or psoas hitch technique when the distal ureteral stump is preserved.

La técnica microquirúrgica en la ureteroureterostomía; experiencia en el perro

Numerosos métodos se han descrito para realizar una ureteroureterostomía, desde que Spof la realizó por primera vez en 1896. En un gran número de casos no se garantizaba la continuidad del tractus urinario hasta el advenimiento de la microcirugía. Nuestro objetivo es demostrar experimentalmente las bondades de la técnica microquirúrgica, para lo cual se utilizaron un total de 15 perros Beagles, a los cuales se les realizó la sección y anastomosis de ambos uréteres. La sutura se debe realizar con nylon monofilamento con aguja espatulada 10-0, de forma siempre sero-muscular. Los resultados que se obtuvieron fueron satisfactorios al 100 % en todos los animales y no fue necesario el uso de microscopio, pues una gafa-lupa de 2,3 aumentos es suficiente. Este método se debe tener en cuenta en el trasplante renal, ya que ésta sería la mejor técnica antirreflujo.

Many method to perform an ureteroureterostomy have been described, since Spof performed it for the first time in 1896. In a great amount of cases, the continuity of the urinary tract could not be guaranted until the advent of microsurgery. The aim of the authors is to demonstrate experimentally the advantages of the microsurgical trechnique, and thus 15 Beagle dogs were used. All of them had both ureters sectioned and anastomosed. Suture must be accomplished with nylon monofilament with a 10-0 spatulated needle, always in a seromuscular way. Results were satisfactory in a 100 % in all the animals, and the use of the microscope was not necessary, since the 2,3 enlargements augmentation glasses were enough. This method must be kept in mind in case of renal transplantation, since this would be the best anti-reflux technique.

Two Cases of Traumatic Ureteral Injury / 대한비뇨기과학회지

Recently with the increase of traffic accident and industrial disaster, incidence of urogenital injury is progressively increasing year by year, but traumatic ureteral injury is still very rare. Herein is reported the observation on two cases of traumatic ureteral injury due to traffic accident which has been treated successfully by ureteroureterostomy.