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DISTAL URETERO-URETEROSTOMY THROUGH AN INGUINAL INCISION: STEP BY STEP VIDEO
Yacoub Jafar, MD, Melissa McGrath, BASc, BRUNO LESLIE, MD, Luis H. Braga, MD, MSc, PhD.
McMaster University, Hamilton, ON, Canada.

BACKGROUND: We will present a step by step video on how to perform a distal ipsilateral uretero-ureterostomy through a transverse 2.5 cm inguinal incision.
METHODS: A 4-month old baby girl was referred to our outpatient clinic for assessment of a right duplex system with upper pole hydroureteronephrosis diagnosed prenatally. The 3-month ultrasound confirmed right upper pole hydroureteronephrosis with no dilatation of the lower moiety. Voiding cystourethrography (VCUG) revealed no lower pole vesicoureteral reflux (VUR). Therefore, the presumptive diagnosis was of a right upper pole ectopic ureter with no lower pole VUR. The child underwent a right distal ipsilateral uretero-ureterostomy through a 2.5 cm transverse inguinal incision.RESULTS: Operative time was 70 minutes from skin to skin. Neither cystoscopy nor retrograde pyelogram were performed at the start of the procedure. The patient had an uneventful recovery, requiring no narcotics and was discharged on postoperative day one, after removal of Foley catheter. Postoperative ultrasound showed resolution of the upper pole hydroureteronephrosis with preservation of the renal parenchyma.CONCLUSION: Distal uretero-ureterostomy is a minimally invasive technique that can be done efficiently in small infants, with very successful outcomes. The surgical steps demonstrated in this video allow for safely implementation of this procedure at other institutions.


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