title: Wrap plication of megaureter around normal-sized ureter for complete duplex system reimplantations.
abstract: OBJECTIVE
  A duplex collecting system is a common congenital renal tract abnormality associated with different clinical problems. We describe our experience with ureteral reimplantations of a complete duplex collecting system where 1 megaureter needing recalibration and 1 normal-sized ureter coexisted. Recalibration of the megaureter was done by wrap plication around the normal-sized ureter.
  
  
  METHODS
  Operative logs and case notes were reviewed of consecutive children with a complete duplex collecting system treated with wrap plication of the megaureter around the normal-sized ureter and reimplantation between 1997 and 2010. Reoperation, vesicoureteral reflux and obstruction rates were assessed.
  
  
  RESULTS
  A total of 25 children underwent wrap plication and ureteral reimplantation. Of the cases 19 (76%) were completely successful and 6 (24%) needed reoperation. Three children (12%) had persistent high grade vesicoureteral reflux, 2 (8%) underwent endoscopic correction and 1 (4%) underwent repeat reimplantation of the duplex system. Three children (12%) had postoperative obstruction and 2 (8%) underwent endoscopic incision of the ureteral orifice. In 1 child (4%) a nonfunctioning lower moiety of the kidney developed, which was managed by heminephrectomy.
  
  
  CONCLUSIONS
  Wrap plication of a megaureter around the normal-sized ureter before reimplantation seems to be a relatively safe method in the surgical management of children with a complete duplex collecting system of the kidney. Sufficient spatulation of the lower pole ureter seems to be crucial.
authors.affiliation: Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands. m.m.c.vandenheijkant@umcutrecht.nl
authors.forename: M M C
authors.initials: MM
authors.lastname: van den Heijkant
authors.forename: P
authors.initials: P
authors.lastname: Dik
authors.forename: A J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: R
authors.initials: R
authors.lastname: Chrzan
authors.forename: C F
authors.initials: CF
authors.lastname: Kuijper
authors.forename: T P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012092:Replantation; D012189:Retrospective Studies; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods