title: Complications after common sheath reimplantation in pediatric patients with complicated duplex system.
abstract: OBJECTIVE
  To report our experience of common sheath reimplantation (CSR) for ectopic ureterocele (EU) combined with ureteral duplication, describing success rates and postoperative complications, along with risk factors for developing postoperative incontinence.
  
  
  METHODS
  When the upper tract approach is not indicated in patients with EU, a bladder-level approach, involving either CSR or total reconstruction, is the remaining option. However, concerns exist about the high morbidity of bladder-level approaches. We retrospectively examined the postoperative results of 39 patients who underwent CSR between January 2001 and December 2012. Risk factors for the development of postoperative incontinence and decreases in differential renal function (DRF) were additionally analyzed.
  
  
  RESULTS
  The median age at operation was 16.5 months. After CSR, upper urinary tract dilatation decreased in 36 patients (92.3%). During a median follow-up of 75.9 months, an additional operation was required in 7 patients (17.9%). Postoperative incontinence developed in 3 patients (7.7%). Median preoperative DRF was significantly lower in the postoperative incontinence group (P = .004). DRF decreased postoperatively in 5 of 36 patients (13.9%). No preoperative factors were related to the decrease in DRF. No patient developed hypertension or proteinuria.
  
  
  CONCLUSIONS
  CSR decompressed the upper urinary tract effectively in our EU patients. Postoperative incontinence does not seem to be related to operation factors, but with preoperative DRF. When the upper tract approach is not indicated, CSR is a reasonable alternative. Total reconstruction is unnecessary as the remnant upper pole kidney after CSR does not lead to complications.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong Seung
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.affiliation: Department of Pediatric Urology, Severance Children's Hospital, Seoul, Republic of Korea.
authors.forename: Sang Hee
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Rosito T
authors.initials: RT
authors.lastname: Bascuna
authors.affiliation: Department of Urology, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ha
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: swhan@yuhs.ac.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014518:Ureterocele / Q000150:complications* / Q000601:surgery*; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000379:methods