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Wang D, Cui M, Chu X, Han X, Liu P, Zhao X, Fan Y. Risk factor of postoperative adverse events among children with duplex kidney undergoing upper pole heminephrectomy: a single-center experience. Front Pediatr 2024; 12:1305456. [PMID: 38742242 PMCID: PMC11089135 DOI: 10.3389/fped.2024.1305456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The aim of this study was to identify the risk factors for postoperative adverse events in children with duplex kidney undergoing upper pole heminephrectomy. Methods We collected clinical data from pediatric patients with duplex kidney who underwent upper pole heminephrectomy. Based on the presence or absence of postoperative adverse events, the patients were divided into two groups: an adverse events group (n = 16) and a non- adverse events group (n = 37), using multivariate logistic regression analysis to screen for independent risk factors for postoperative adverse events. Results Through univariate and multivariate analysis, we found that the presence of upper renal ureterocele (P = 0.042, OR = 7.116, 95% CI 1.073-47.172), as well as the presence of accessory renal artery type (P = 0.016, OR = 10.639, 95% CI 1.551-72.978) and other types (P = 0.039, OR = 3.644, 95% CI 0.351-37.836) as the upper kidney's blood supply artery increase the risk of postoperative adverse events, with these differences being statistically significant. Conclusions In pediatric patients with duplex kidney undergoing upper pole heminephrectomy, the presence of upper renal ureterocele and the presence of accessory renal artery type and other types as the upper kidney's blood supply artery are independent risk factors for postoperative adverse events.
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Affiliation(s)
- Denghui Wang
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjie Cui
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyang Chu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojiang Han
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengpeng Liu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Zhao
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingzhong Fan
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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2
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Nulens K, Lorenzo AJ, Dos Santos J, Ellul K, Rickard M. Fetal urinary tract dilation: What to tell the parents. Prenat Diagn 2024; 44:148-157. [PMID: 38117007 DOI: 10.1002/pd.6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
Urinary tract dilation (UTD), which refers to the abnormal dilation of the urinary collection system, is the most common finding on prenatal ultrasound and presents with varying severity, presentation, etiology, and prognosis. Prenatal classification and risk stratification aim to prevent postnatal complications, such as urinary tract infections and further kidney dysfunction. Parents expecting a child with UTD should be counseled by a multidisciplinary team consisting of maternal-fetal medicine specialists, and pediatric urology and nephrology providers. This review summarizes the key points in the diagnostic evaluation and management during the prenatal and initial postnatal period, focusing on the information that should be provided to future parents. We address frequently asked parental questions and concerns that our multidisciplinary clinical practice faces.
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Affiliation(s)
- Katrien Nulens
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Katie Ellul
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Hussain SNF, Phillips LAF, Godse A, Lall A, Gopal M. Ureteric Clipping for the Treatment of Urinary Incontinence in Girls With Ectopic Ureters: Predicting Who Is Going to Dilate and Does It Matter? Urology 2024; 184:199-205. [PMID: 37952605 DOI: 10.1016/j.urology.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To assess the effectiveness and midterm follow-up of laparoscopic upper pole ectopic ureteral clipping to treat urinary incontinence in girls with duplex kidneys and non/poorly functioning upper pole moieties. To see if preoperative characteristics increased the likelihood of significant postoperative dilatation and whether this dilation has clinical significance. METHODS A database review identified children who had undergone ureteric clipping at our institution. Patient details assessed included: age at presentation, age at procedure, significant past medical history, preoperative investigations, operative time, length of stay, postoperative symptoms, postoperative renal tract ultrasound findings and the need for subsequent intervention. RESULTS Six girls underwent clipping between March 2018 and May 2021. The mean age at presentation and surgery were 77months (39-186) and 86months (44-193), respectively. The mean operative time was 94 minutes (range 66-128 minutes). The median length of stay was 1 day (range 0-3days). All the girls were dry immediately after the procedure. During a mean follow-up of 51months (29-66) all children have remained symptom-free and required no further intervention. Two children have developed significant (>30 mm) but stable ureteric dilatation after clipping but have remained asymptomatic and therefore are continuing on conservative follow-up. Both these children had dilated ureters (>10 mm) preoperatively. CONCLUSION Ureteric clipping is quick, safe, and effective option in dealing with incontinence due to ectopic upper pole ureters in girls. Children with preoperative ureteric dilation seem to be at increased risk of postoperative dilation. However, as they remain asymptomatic, the clinical significance of this dilatation is unclear.
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Affiliation(s)
| | | | - Alok Godse
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Anupam Lall
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Milan Gopal
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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Pohl HG. Embryology, Treatment, and Outcomes of Ureteroceles in Children. Urol Clin North Am 2023; 50:371-389. [PMID: 37385701 DOI: 10.1016/j.ucl.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
A ureterocele is a congenital cystic dilatation of the intravesical ureter that may affect either a single system kidney or the upper pole of a duplex system. The position of ureteral orifice correlates with function of associated renal moiety. Ureteroceles associated with good renal function and prompt drainage or ureteroceles associated with no renal function can be managed nonoperatively. Endoscopic puncture of ureteroceles addresses most cases; iatrogenic reflux may rarely require secondary surgery. Robot-assisted laparoscopic upper pole nephroureterectomy and ureteroureterostomy procedures are rarely associated with complications.
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Affiliation(s)
- Hans G Pohl
- Urology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Urology, Children's National Hospital, 111 Michigan Avenue, NW, Suite WW-4400, Washington, DC 20010, USA.
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Bilateral complete duplication of ureter with ectopic ureter presenting as persistent urinary dribbling with normal voiding pattern in 17-year-old female: Case report. Ann Med Surg (Lond) 2022; 84:104824. [PMID: 36582920 PMCID: PMC9793118 DOI: 10.1016/j.amsu.2022.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction and importance: Bilateral complete ureteral duplication is a rare urinary tract abnormality and presence of unilateral ectopic ureter makes it a rarest entity. Continuous urinary dribbling with normal voiding pattern and recurrent UTI are frequent presenting complains in case of ectopic ureter. Long term childhood problem of urinary incontinence with delayed diagnosis in adult in this case makes it a perfect case to report. Presentation of case We present a case of 17-year-old girl with continuous urinary dribbling and constant wetting with normal voiding pattern since childhood. She also had recurrent history of urinary tract infections. Clinical findings and investigations Local external examination of genitourinary system was found to be normal. There were skin lesions on buttocks and thighs suggestive of urine dermatitis. There were no examination findings of other congenital anomalies. Complete blood count, Renal function test, Serology, Urine R/ME, Urine culture and sensitivity, Ultrasound abdomen and pelvis, Computed Tomography scan, intraoperative cystoscopy were done. Intervention and outcome Right upper pole hemi nephroureterectomy was performed. She was post operatively managed with IV Fluids, antibiotics, analgesics, antipyretics and antiemetics. She is asymptomatic now and regularly followed up on OPD basis. Relevance and impact Congenital abnormalities of the genitourinary system like ectopic ureter should be clinically suspected in case of persistent urinary problems like urinary dribbling with normal voiding pattern and recurrent urinary tract infections. Upper pole heminephrectomy is an ideal choice of treatment in case of nonfunctional upper moiety. This case emphasizes the early detection of genitourinary abnormalities and provide the perspective on late diagnosis and management in such cases.
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Li Z, Psooy K, Morris M, Dharamsi N, Retrosi G. Laparoscopic ligation of ectopic ureter in pediatric patients: a safe surgical option for the management of urinary incontinence due to ectopic ureters. Pediatr Surg Int 2021; 37:667-671. [PMID: 33449158 DOI: 10.1007/s00383-020-04852-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ureteric ectopia is a pediatric urinary incontinence cause in girls. It is traditionally managed through hemi-nephrectomy or uretero-ureterostomy, which have the potential for complications including anastomotic stricture, leak, bleeding, and de-vascularization of the functioning renal moiety. Laparoscopic ureteric clipping has been shown to be a good alternative but has not been widely adopted yet. We provide our experience with this technique. METHODS We retrospectively reviewed the data of 6 patients who underwent laparoscopic clipping of ectopic ureter between 2014 and 2019. We collected the following information: clinical presentation, preoperative and postoperative imaging, age at presentation, age at surgery, operative time, complications, length of stay, length of follow-up, as well as continence outcomes. RESULTS Five patients were diagnosed with a duplex system associated with an ectopic upper pole ureter. One patient was noted to have a non-functional kidney associated with an ectopic ureter. Median age at presentation was 5 years (6 weeks-9 years), while at surgery was 8 years (2-13 years). Four patients were referred for incontinence, 1 was referred for antenatal hydronephrosis, 1 presented with urosepsis. The preoperative renal pelvis anteroposterior diameter (APD) was 8.60 cm (median) (6.80-8.70 cm). At the post-operative follow-up, the APD increased to median 9.1 cm (6.80-11.50 cm). Median operative time was 91 min (42-60 min). Complications were seen in only one patient who developed an immediate postoperative urinary tract infection (UTI). Five patients were discharged home the same day of the surgery, while the patient who developed UTI went home on post-operative day 3. Median follow-up was 33 months (22-72 months). Currently, all patients have achieved daytime urinary continence. No patient had UTI during the follow-up period. CONCLUSION Laparoscopic ureteric clipping of the ectopic ureter appears to be a valid alternative to extirpative or reconstructive procedures. Follow-up shows an increase in hydronephrosis without any consequence for the patients. Further studies are necessary to reinforce these observations.
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Affiliation(s)
- Zack Li
- Division of Pediatric Urology, Department of Surgery, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Karen Psooy
- Division of Pediatric Urology, Department of Surgery, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Melanie Morris
- Division of Pediatric General Surgery, Department of Surgery, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Nafisa Dharamsi
- Division of Pediatric Urology, Department of Surgery, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Giuseppe Retrosi
- Division of Pediatric General Surgery, Department of Surgery, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Nakahara Y, Nakada S, Hitomi K, Hanaki S, Doi K, Goto T, Aoyama K. Urological anomalies associated with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ureteral clipping for the treatment of a non-functioning upper kidney moiety associated with a massive ureterocele: step-by-step description of a novel technique. J Pediatr Urol 2019; 15:284-285. [PMID: 30981638 DOI: 10.1016/j.jpurol.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/04/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. MATERIALS AND METHODS In this video, one case is presented to demonstrate this novel technique. A nine-year-old boy presented with progressive lower urinary tract symptoms. Radiological workup depicted a duplex kidney on the left side with the absence of function on the upper pole and hydroureteronephrosis with a massive ureterocele. Laparoscopic ureteral transection, drainage, and ligation of both extremities of the enlarged ureter (upper pole ureter) were performed. RESULTS Immediately after ureteral ligation, ultrasonic evidence of ureterocele decompression and improved hydroureteronephrosis was observed. This patient remained asymptomatic without postoperative complications after 3 years. De novo reflux was not observed. CONCLUSION Ureteral ligation, as demonstrated in the video, is a good approach for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. Compared with the current standard techniques (incision/puncture), ureteral ligation has the clear advantage of not causing 'de novo reflux' or unsuccessful de-obstruction, and is not as surgically demanding as other reconstructive/ablative techniques. The disadvantage is the need of regular clinical and ultrasonographic follow-up.
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Neheman A, Kord E, Strine AC, VanderBrink BA, Minevich EA, DeFoor WR, Reddy PP, Noh PH. Pediatric Partial Nephrectomy for Upper Urinary Tract Duplication Anomalies: A Comparison Between Different Surgical Approaches and Techniques. Urology 2019; 125:196-201. [DOI: 10.1016/j.urology.2018.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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Re: Clinical Outcomes of the Upper Urinary Tract after Ureteral Clipping for Treatment of Low Functioning or Nonfunctioning Renal Moieties. Eur Urol 2019; 75:197. [DOI: 10.1016/j.eururo.2018.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/19/2018] [Indexed: 11/20/2022]
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Sheth KR, White JT, Janzen N, Koh CJ, Austin PF, Roth DR, Tu DD, Mittal A, Wang MH, Gonzales ET, Jorgez C, Seth A. Evaluating Outcomes of Differential Surgical Management of Nonfunctioning Upper Pole Renal Moieties in Duplex Collecting Systems. Urology 2018; 123:198-203. [PMID: 30031832 DOI: 10.1016/j.urology.2018.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/08/2018] [Accepted: 06/17/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the management and clinical outcomes of nonfunctioning upper pole moieties treated with either upper pole heminephrectomy or upper pole preservation with lower ureteral reconstruction at a single tertiary institution. METHODS After Institutional Review Board (IRB) approval, patients with duplicated systems undergoing upper pole heminephrectomy, ureteroureterostomy, or common sheath ureteral reimplantation from 2012-2017 were identified. Only patients with a nonfunctioning upper pole moiety on ultrasound or renal scan were included. Patients undergoing upper pole heminephrectomy were compared to those undergoing upper pole preservation with respect to demographics, anatomic variations preoperatively, and postoperative outcomes. RESULTS Twenty-seven (57%) patients underwent upper pole preservation with lower ureteral reconstruction; 20 (43%) patients underwent upper pole heminephrectomy. Patients undergoing lower ureteral reconstruction were older (1.63 vs 2.76 years, P = .018) and more commonly presented with lower pole vesicoureteral reflux (67% vs 25%, P = .008). No significant difference in postoperative complications was seen between the two groups. After ureteroureterostomy, one patient developed new onset symptomatic reflux to the upper pole requiring intravesical reimplantation. In the heminephrectomy group, 4 of 11 patients with ureteroceles had ureterocelectomy with concomitant lower pole reimplantation. After heminephrectomy, two additional patients required further interventions: ureterocele excision and transurethral polyp excision. CONCLUSION For patients with nonfunctional upper poles, lower tract reconstruction is a safe alternative to upper pole heminephrectomy. No significant difference in outcomes was seen. Considering that nearly 1 of 3 of patients with upper pole heminephrectomy required additional lower urinary tract procedures, pursuing upper pole preservation with lower urinary tract reconstruction may be favorable.
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Affiliation(s)
- Kunj R Sheth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Jeffrey T White
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nicolette Janzen
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Chester J Koh
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Paul F Austin
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - David R Roth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Duong D Tu
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Angela Mittal
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Ming-Hsien Wang
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Edmond T Gonzales
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Carolina Jorgez
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Abhishek Seth
- Texas Children's Hospital, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Le HK, Chiang G. Long-term Management of Ureterocele in Duplex Collecting Systems: Reconstruction Implications. Curr Urol Rep 2018; 19:14. [DOI: 10.1007/s11934-018-0758-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Duicu C, Kiss E, Simu I, Aldea C. A Rare Case of Double-System With Ectopic Ureteral Openings Into Vagina. Front Pediatr 2018; 6:176. [PMID: 29974045 PMCID: PMC6020766 DOI: 10.3389/fped.2018.00176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/29/2018] [Indexed: 02/05/2023] Open
Abstract
The presence of an ectopic ureter may be indicated by continuous wetting, despite a normal voiding pattern, especially in girls. In most cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 5-year-old girl presented with urinary incontinence regardless of the successful toilet training and a suspicion of left duplex kidney on a previous ultrasound. Contrast-enhanced computed tomography revealed a double left kidney with double ureters, both inserting together into the vagina. The surgical treatment consisted in the "en block" reimplantation of the ectopic ureters into the bladder, with complete resolution of the symptoms. The reported case does not represent just a typical presentation of a single ectopic ureter, as the duplex kidney system had ectopic both ipsilateral ureters (with insertion into the vagina). This case reminds us that congenital abnormalities of the genito-urinary tract should be considered in case of urinary incontinence and recurrent urinary tract infections.
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Affiliation(s)
- Carmen Duicu
- 1st Department of Paediatrics, University of Medicine and Pharmacy, Târgu Mureş, Romania
| | - Eva Kiss
- 1st Department of Paediatrics, University of Medicine and Pharmacy, Târgu Mureş, Romania
| | - Iunius Simu
- Radiology Department, University of Medicine and Pharmacy, Târgu Mureş, Romania
| | - Cornel Aldea
- Pediatric Nephrology Department, Emergency Clinical Hospital for Children Cluj-Napoca, Cluj-Napoca, Romania
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Lopes RI, Fernandez N, Koyle MA, Dos Santos J, Perez J, Romao R, Lorenzo AJ. Clinical Outcomes of the Upper Urinary Tract after Ureteral Clipping for Treatment of Low Functioning or Nonfunctioning Renal Moieties. J Urol 2017; 199:558-564. [PMID: 28943272 DOI: 10.1016/j.juro.2017.09.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A growing body of evidence suggests that it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. We present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles. MATERIALS AND METHODS We prospectively collected data for 35 consecutive patients (23 females and 12 males) who underwent ureteral clipping between February 2011 and August 2016. Patients were divided into 4 groups consisting of 1) duplex system with ectopic ureter (45.7%), 2) duplex system with a large ureterocele (11.4%), 3) other duplex system (8.6%) and 4) single system kidneys (34.3%). Patients were followed for clinical outcomes and hydronephrosis trends. Comparisons included preoperative and postoperative anteroposterior diameter, maximal ureteral diameter and ureterocele size. RESULTS Median age at surgery was 59 months (IQR 11 to 120, range 5 to 216). Median ± SD operative time was 108.9 ± 31.1 minutes (range 20 to 180) and median length of stay was 7.5 hours (IQR 6 to 19, range 5 to 336). Immediate resolution of urinary incontinence was observed in all 16 ectopic ureter cases. After a median ± SD followup of 20.8 ± 13.8 months (IQR 8.5 to 30, range 6 to 50) 97.2% of the patients remained asymptomatic. No significant differences were observed between initial and last anteroposterior diameter measurements except in group 1 (p = 0.001). All ureteroceles demonstrated a significant decrease in median ± SD size after clipping (from 2.7 ± 0.41 to 0.53 ± 0.92 cm, p = 0.003). Pyonephrosis developed in 1 patient, who underwent laparoscopic nephrectomy. CONCLUSIONS 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.
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Affiliation(s)
- Roberto Iglesias Lopes
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Nicolas Fernandez
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Martin A Koyle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jaime Perez
- Division of Urology, Pontificia Universidad Javeriana and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Rodrigo Romao
- Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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15
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A Move to Conservativism in Pediatric Urology. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ellison JS, Lendvay TS. Robot-assisted ureteroureterostomy in pediatric patients: current perspectives. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:45-55. [PMID: 30697563 PMCID: PMC6193430 DOI: 10.2147/rsrr.s99536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
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Laparoscopic selective clipping of upper moiety vasculature and ureter without partial nephrectomy: A novel technique for pediatric urinary incontinence due to ectopic ureter associated with poor functioning upper renal moiety. J Pediatr Urol 2017; 13:217-218. [PMID: 28126394 DOI: 10.1016/j.jpurol.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to present a novel laparoscopic technique for persistent urinary incontinence in pediatrics due to ectopic ureter associated with poor functioning upper renal moiety. METHODS This technique consisted of laparoscopic clipping of the upper moiety artery and vein. The ectopic ureter was also clipped afterwards without upper pole partial nephrectomy. RESULTS The patient was a seven-year-old girl with persistent urinary incontinence and confirmation of duplex kidney with poor functioning upper moiety in pre-operative investigations. The upper moiety ureter was ectopically drained to the vaginal cavity. She was immediately dry after surgery and discharged on the second postoperative day. During the follow-up period of 14 months, she was continent and symptom-free. Hydronephrosis was not visualized in follow-up ultrasonography. CONCLUSIONS This laparoscopic upper renal moiety vascular and ureteral clipping without partial nephrectomy could serve as a promising, safe and simple alternative in the treatment of patients with ectopic ureter associated with poor functioning renal moiety. Also, ipsilateral normal functioning moiety would not be associated with potential morbidity in this technique.
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Ortiz R, Parente A, Burgos L, Angulo JM. Endoscopic Urinary Diversion As Initial Management of Symptomatic Obstructive Ectopic Ureter in Infants. Front Pediatr 2017; 5:208. [PMID: 29085813 PMCID: PMC5649138 DOI: 10.3389/fped.2017.00208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
Abstract
AIM Definitive surgery of ectopic ureter in infants is challenging. We propose an endoscopic urinary diversion (EUD) as a novel surgical technique in the initial management of symptomatic obstructive ectopic ureter. PATIENTS AND METHODS Sixteen obstructive ectopic ureters (14 patients) were initially treated by EUD between 2006 and 2015. All patients had urinary tract dilatation worsening at preoperative US scans and at least two febrile urinary tract infection (UTI) or urinary sepsis despite antibiotic prophylaxis. Ectopic ureter was confirmed by cystoscopy. When ectopic meatus was not found, EUD consisted in the creation of a transurethral neo-orifice (TUNO) performed by needle puncturing of the ureterovesical wall, under fluoroscopic and ultrasound control. If ectopic meatus was identified in the posterior urethra, "intravesicalization procedure" was done opening the urethral-ureteral wall to create a new ureteral outlet into the bladder. RESULTS EUD was done at a median age of 3.5 months (0.5-7) with median follow-up of 48 months (24-136). TUNO was performed in six patients and "intravesicalization" in eight patients. Significant differences were observed in ureteral diameter and anteroposterior pelvis diameter before and after endoscopic treatment (p < 0.005). Initial renal function was preserved in all cases. Postoperative complications were UTI in four patients and TUNO stenosis in one patient, treated by endoscopic balloon dilation. Definitive treatment was further individualized in each patient after 1 year of life. CONCLUSION EUD is a feasible and safe less-invasive technique in the initial management of symptomatic obstructive ectopic ureter. It allows an adequate ureteral drainage preserving renal function until definitive repair if necessary and does not invalidate other surgical options in case of failure or future definitive treatments.
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Affiliation(s)
- Ruben Ortiz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Parente
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Burgos
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Saltzman A, Roth CC. A Curious Case of Continuous Incontinence. Urology 2016; 92:113-6. [PMID: 26898899 DOI: 10.1016/j.urology.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 11/16/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
Obstructed hemivagina, ipsilateral renal anomaly (OHVIRA) is a rare Müllerian duct abnormality with renal manifestations. Classical presentation is an adolescent female with abdominal pain following menarche. Because of its rarity, diagnosis is often delayed. There have been <20 reported cases of prepubertal OHVIRA. We present a case of missed OHVIRA diagnosis that presented with continuous incontinence following incision of the obstructed hemivagina and discuss the current medical literature on this subject.
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Affiliation(s)
- Amanda Saltzman
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA
| | - Christopher C Roth
- Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA; Children's Hospital of New Orleans, Department of Urology, New Orleans, LA.
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Pérez Niño J. Comentario editorial a «Anastomosis ureteroureteral: una alternativa para pacientes con enfermedad asociada a doble sistema colector». Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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