title: Ureterocalicostomy in children: 12 years experience in a single centre.
abstract: OBJECTIVE
  • To document the outcome of ureterocalicostomy in children.
  
  
  METHODS
  • The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively. • Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi-ureteric junction (PUJ) obstruction. • In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty. • An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically-assisted technique.
  
  
  RESULTS
  • Mean age at operation was 9.3 years and the mean (range) duration of follow-up was 2.6 (0.3-7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging. • However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow-up to 3 years.
  
  
  CONCLUSIONS
  • Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. • Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.
authors.affiliation: Department of Paediatric Urology, Leeds General Infirmary, St James's University Hospital, Leeds, UK. annaradford@doctors.net.uk
authors.forename: Anna R
authors.initials: AR
authors.lastname: Radford
authors.forename: David F M
authors.initials: DF
authors.lastname: Thomas
authors.forename: Ramnath
authors.initials: R
authors.lastname: Subramaniam
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D007670:Kidney Calices / Q000601:surgery*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*