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Ureteroureterostomy irrespective of ureteral size or upper pole function: A single center experience
Daryl J. McLeod, MD, Seth A. Alpert, MD, Venkata R. Jayanthi, MD.
Nationwide Children's Hospital, Columbus, OH, USA.

BACKGROUND:Though ureteroureterostomy (UU) is an established procedure for treatment of duplex anomalies, there may be a reluctance to apply this approach to patients with poor upper pole function and/or marked degrees of ureteral dilation.
METHODS: An IRB- approved retrospective analysis of all patients undergoing UU at our institution between 2006 and present was performed. All patients underwent an end-to-side anastomosis with a double J stent left in the lower pole ureter. Laparoscopic repairs were done "high" and open repairs were done "low". If the upper pole ureter remained massively dilated after transection, the ureter was partially closed to reduce the length of the anastomosis. Data collected included demographics, diagnosis, surgical interventions, imaging studies and outcomes.
RESULTS: A total of 41 patients (43 renal units) were identified. There were 35 females and 6 males with average age at surgery of 2.3 years (range 55d-15.9y ) and average follow up of 2.8 years. Diagnosis included ureterocele (17), ectopic duplex ureter (25), and ureteral triplication (1). Thirty-six patients underwent UU only and 5 UU with simultaneous lower pole reimplantation. Twelve of the 41 patients, (30%) underwent laparoscopic repair. Twelve of the 43 renal units, (28%) required ureteral tapering, of which 3 were performed laparoscopically. Preoperative renography with upper and lower pole differential function was available in 24 patients. Median upper pole function was 17% (0-35%). Six patients had no measurable function and 10 had <15%. No patient developed lower pole hydronephrosis in the follow up period. There were two complications. One patient was found to have a post-operative UVJ stricture (patent anastomosis) requiring balloon dilation and one developed an anastomotic stricture necessitating upper pole nephrectomy. No other complications have been identified in the remaining patients related to retained upper pole segments.
CONCLUSIONS: Ureteroureterostomy is a safe and effective way of reconstructing duplex anomalies even with poorly functioning and massively dilated upper pole segments. This technique appears to have no identifiable negative effect on the lower pole system. The concept of automatically removing "dysplastic" upper pole segments needs to be re-evaluate.


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