A growing body of evidence suggest it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. Herein, we present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles.
Prospective data collection on 35 consecutive patients (23 female, 12 male) who underwent ureteral clipping between 02/2011 and 08/2016. Patients were divided in four groups [I: duplex system (DS) with ectopic ureter (45.7%); II: DS with a large ureterocele (11.4%); III: other DS (8.6%); IV: single-system kidneys (34.3%)], and followed for clinical outcomes and hydronephrosis trends. Comparisons included pre- and post-operative anteroposterior diameter (APd), maximal ureteral diameter and ureterocele size.
Median age at surgery was 59 months (IQR 11-120; range: 5-216). Median operative time was 108.9±31.1 min (range 20-180) and length of stay 7.5 hours (IQR 6-19; range: 5-336). Immediate resolution of urinary incontinence was observed in all ectopic ureter cases (n=16). After a median follow-up of 20.8±13.8 months (IQR 8.5-30; range: 3-50), 97.2% of the patients remain asymptomatic. No significant differences were observed between initial and last APd measures in all patients except for group I (p=0.001). All ureteroceles showed significant decrease in size after clipping (2.7±0.41 cm to 0.53±0.92 cm, p=0.003). One patient developed pyonephrosis and underwent a laparoscopic nephrectomy.
Ureteral clipping appears to be a reasonable, safe and effective option for pediatric patients in the reported settings, with the potential to be simpler and quicker than extirpative or reconstructive procedures.
The Journal of urology. 2017 Sep 21 [Epub ahead of print]
Roberto Iglesias Lopes, Nicolas Fernandez, Martin A Koyle, Joana Dos Santos, Jaime Perez, Rodrigo Romao, Armando J Lorenzo
Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Pontificia Universidad Javeriana, Bogota, Colombia., Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Division of Urology, Pontificia Universidad Javeriana, Bogota, Colombia., Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada., Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: .