Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children.
Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children. Demographic data of patients, their clinical manifestations, classification of hydronephrosis based on the guidelines established by the Society for Fetal Urology (SFU), dimensions of the renal pelvis measured in the anterior-posterior direction (APD), diameters of the ureters, duration of surgical procedures, duration of hospitalization, and subsequent follow-up information were systematically gathered prospectively to evaluate the long-term outcomes of the proposing surgical technique.
Study Type
OBSERVATIONAL
Enrollment
40
A 12 mm transverse incision was made just above the iliac crest, followed by careful dissection of the fascia and muscle layer to expose the Gerota's fascia. Entry into the retroperitoneal space was achieved with a 10-mm balloon trocar, allowing for pneumoretroperitoneum establishment. Using a 10-mm laparoscope equipped with a Maryland dissector, the ureters were dissected and isolated, followed by careful exteriorization of both upper and lower pole moiety ureters with a Babcock grasper. The pathological upper pole moiety ureter was transected, preserving the normal lower pole moiety ureter and shared blood supply, and closed with a Vicryl 4/0 suture. Subsequently, an end-to-side ureteroureterostomy was performed with a 6/0 Polydioxanone running suture, with antegrade insertion of a double J stent if not previously conducted. A final retroperitoneoscopic evaluation ensured proper anastomosis alignment, and the incision was closed without drainage.
The National Hospital of Pediatrics
Hanoi, Vietnam
Vinmec Research Institute of Stem Cell and Gene Technology
Hanoi, Vietnam
Mean operating time
The average operating time (minutes) of OTAU
Time frame: through study completion (4 years)
Intraoperative complications
Complications experienced during the procedure
Time frame: through study completion (4 years)
Conversion to open
Incidence in which the operation must be switch to open surgery
Time frame: through study completion (4 years)
Early postoperative complications
Complications after OTAU including UTI and wound infection
Time frame: through study completion (4 years)
Median length of hospital stays
Average time (days) the patient has to stay at the hospital post-operation
Time frame: through study completion (4 years)
Mean UPM renal pelvis' APD
The average anterior-posterior diameter (mm) of the upper pole moiety before and after the operation
Time frame: through study completion (4 years)
Mean SFU of UPM renal pelvis
The average Society of Fetal Urology classification of the upper pole moiety before and after the operation
Time frame: through study completion (4 years)
Mean UPM ureter's diameter
The average ureter's diameter (mm) of the upper pole moiety before and after the operation
Time frame: through study completion (4 years)
Mean UPM DRF
The average differential renal function (%) (measurement of each kidney's ability to extract tracer from blood) of the upper pole moiety before and after operation
Time frame: through study completion (4 years)
Mean DRF of operated side
The average differential renal function (%) of the operated side before and after operation
Time frame: through study completion (4 years)
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