Single-stage surgical approach in complicated paediatric ureteral duplication: surgical and functional outcome.
OBJECTIVE
Surgical approach to children with complicated ureteral duplication is discussed controversially. Our aim was to determine the outcome of children with complicated renal duplication undergoing a single-stage surgical approach with laparoscopic partial nephrectomy and open bladder reconstruction.


METHODS
Data of patients from 2004 to 2008 were investigated retrospectively. Outcome was analyzed in terms of postoperative course, renal function, urinary tract infection and functional voiding.


RESULTS
Thirteen patients were treated with laparoscopic partial nephrectomy and reconstruction of the lower urinary tract in a single-stage approach. Median age at operation was 15 months (2-63 m). One girl had a renal triplication. 7/13 patients presented with an ectopic ureterocele, two with an ectopic ureter, severe vesicoureteral reflux occurred in 6 patients. All patients had non-functioning renal moieties. Mean operative time was 239 min (129-309; SD 50). One re-operation was necessary 4 years after primary surgery due to a pole remnant. All patients had uneventful recoveries without evidence of recurrent UTI. Postoperative 99mTc-MAG3 scans showed no significant reduction of partial renal function (p = 0.4), and no signs of obstruction (p = 0.188). During a median follow-up of 60 months (49-86), dysfunctional voiding occurred in one patient.


CONCLUSIONS
In children with complicated ureteral duplication a definitive single-stage procedure is feasible and shows excellent functional results.
Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Str. 2, 72076, Tuebingen, Germany, verenaellerkamp@gmail.com.
Verena
V
Ellerkamp
Phillip
P
Szavay
Tobias
T
Luithle
Juergen F
JF
Schäfer
Oliver
O
Amon
Joerg
J
Fuchs
D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000601:surgery; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014518:Ureterocele / Q000150:complications; D014552:Urinary Tract Infections / Q000150:complications; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications