title: Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties.
abstract: OBJECTIVE
  A simplified approach for the surgical management of symptomatic ectopic ureters, associated with a non-functioning upper moiety, with laparoscopic ureteric clipping is presented in this research paper.
  
  
  METHODS
  Prospectively collected data on nine consecutive girls with ectopic ureters associated with urinary incontinence who underwent laparoscopic clipping between February 2011 and December 2013. Surgical technique consisted of cystoscopy and insertion of ureteral catheter in the lower pole ureter to aid in identification and clipping of the ectopic ureter, which was achieved by standard trans-peritoneal laparoscopy.
  
  
  RESULTS
  Median age was eight years (range 4-17 years). Diagnosis was based on clinical findings, which were supported by: ultrasound (US), nuclear scans and magnetic resonance urography in Cases 9, 8 and 5, respectively. Bilateral complete duplication was present in two patients; the combination of cystoscopy and laparoscopy allowed adequate identification of the ectopic ureter causing incontinence in both. All nine patients were immediately dry after surgery and remain asymptomatic after a maximum follow up of 27 months. Eight out of nine patients had developed some degree of asymptomatic upper pole hydronephrosis on follow-up US.
  
  
  CONCLUSIONS
  Laparoscopic clipping holds promise as a simple alternative to other more-complex surgical procedures in the treatment of incontinence due to an ectopic ureter. Despite favorable and encouraging initial results, further follow up is warranted in order to determine the fate of expected associated upper-pole hydronephrosis.
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: R L P
authors.initials: RL
authors.lastname: Romao
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: V
authors.initials: V
authors.lastname: Figueroa
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: J L Pippi
authors.initials: JL
authors.lastname: Salle
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: M A
authors.initials: MA
authors.lastname: Koyle
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: D J
authors.initials: DJ
authors.lastname: Bägli
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Electronic address: armando.lorenzo@sickkids.ca.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lorenzo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D011446:Prospective Studies; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery; D014515:Ureteral Diseases / Q000150:complications* / Q000151:congenital / Q000175:diagnosis; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014567:Urography; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Children; Ectopic ureter; Laparoscopy; Ureteral ligation; Urinary incontinence