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A Single Institutional Comparison Between Cutaneous Ureterostomy and Temporary Refluxing Ureteral Reimplantation for the Management of Congenital UVJ Obstruction
Martin Kaefer, MD, Konrad Szymanski, MD, James Grogan, MD, Rosalia Misseri, MD, Benjamin Whittam, MD, Mark Cain, MD, KIrsten Meldrum, MD, Richard Rink, MD.
Indiana University, Indianapolis, IN, USA.

Background: Many options are available for the management of congenital UVJ obstruction in young infants. We compare our experience with the techniques of cutaneous ureterostomy (CU) and temporary refluxing ureteral reimplantation (TRUR) with particular attention to incidence and type of perioperative complications.
Methods: We performed an IRB-approved retrospective review of all patients less than 12 months of age treated over a 12-year span (1999-2011) for congenital UVJ obstruction with either a CU or TRUR. Patients with abnormal bladder function (e.g. PUV, NGB) were excluded. Patients with a diagnosis of ureterocele were also excluded since neither surgical technique would typically be utilized for the treatment of this entity. Data was collected with respect to etiology (primary obstructed megaureter vs. ectopic ureter), laterality (unilateral vs. bilateral) and whether the ureter was part of a duplex or single system. Secondary procedures needed to address complications resulting from the chosen form of diversion were recorded. Patients with less than 1 year of follow up were excluded from analysis. Continuous variables were analyzed with the Mann-Whitney U test. Complication rates were compared with Fisher’s exact test.
Results: Forty-two patients met the criteria for inclusion. Ureterostomies were created in 32 patients (34 ureters: single - 25, duplex - 5, bilateral -2) while TRUR was utilized in 10 patients (13 ureters: single - 6, duplex - 1, bilateral - 3). Average patient age at time of operation was similar between groups (CU: 3.2 months, TRUR: 2.65 months, p = 0.37). All patients had resolution of obstruction. Among the ureterostomy group, 11 patients (34%) experienced one or more complications. The three major complications included bladder defunctionalization requiring continent urinary reconstruction, injury to ipsilateral lower pole ureter and significant loss of renal function from ascending infection. There were 8 cases of stomal stenosis (25%) that occurred at a median 2.8 months (range 1.5-13.5 months) following CU. In contrast, there were no cases of a stenosis in the patients treated with TRUR (one patient did have a temporary ureteral stent placed for management of immediate postoperative edema). All 3 patients with bilateral TRUR have maintained excellent bladder capacity as a result of continued bladder cycling. Complication rates approached but did not reach statistical significance between the CU and TRUR groups (34% vs. 10%, respectively, p=0.14)
Conclusions: Temporary refluxing ureteral reimplantation relieves UVJ obstruction while avoiding many of the potential complications encountered following cutaneous ureterostomy.


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