ESPU Meeting on Thursday 18, April 2024, 15:50 - 16:30
15:50 - 15:53
S12-1 (OP)
Neehar PATIL 1, Tarun JAVALI 2 and Padmalatha KADAMABA 1
1) RAMAIAH MEDICAL COLLEGE AND HOSPITAL, PEDIATRIC SURGERY AND PEDIATRIC UROLOGY, Bengaluru, INDIA - 2) RAMAIAH MEDICAL COLLEGE AND HOSPITAL, UROLOGY, Bengaluru, INDIA
PURPOSE
There is paucity of literature in management of infants with primary obstructive megaureters un- dergoing upfront primary repair (extravesical ureteral re implantation).
MATERIAL AND METHODS
This was retrospective analysis of a prospectively maintained data (2005 - 2021). Infants <1 year with unilateral primary obstructive megaureter were included. They were in 2 groups: those undergoing upfront extra- vesical ureteric reimplantation during infancy -Primary Repair (PR), and those initially undergoing a low end cutaneous ureterostomy during infancy followed by intravesical ureteric reimplantation after 1 year of age -Delayed staged repair (DSR). Children presenting with sepsis, in whom a diversion was imperative, were excluded. The 1st year and 3rd year followup details after their definitive repair (with a renal ultrasound, diuretic renogram, estimated glomerular filtration rate and assessment of voiding dysfunction if present) were collated and analysed.Failure was defined as persistent obstructive pattern with worsening renal function or presence of high grade reflux with recurrent breakthrough infections; both of which necessitated a redo reim- plantation.
RESULTS
There were 18 in Primary repair and 16 in Delayed Staged Repair. Urinary tract infections was the commonest presenting symptom amongst both groups i.e. > 50%.The post operative complication rate was 11% in Primary repair and 31% in Delayed Staged Repair. One child in each of the groups (2 girls) required redo reimplantation (5.8%). At the end of the 3rd year follow up (from definitive repair) there was significant reduction in hydronephrosis, improvement in renal function with no obstruction and improvement in estimated glomerular filtration rate amongst all in both groups which was statistically significant i.e. p < 0.05. The success rate was 94.4% -Primary Repair and 93.75% -Delayed Staged Repair.Mean follow up was 9.7 years in Primary Repair , 9 years in Delayed Staged Repair.
CONCLUSIONS
Primary extravesical ureteral reimplantation may be considered as the preferred line of management of unilateral obstructed megaureters during infancy.
15:53 - 15:56
S12-2 (OP)
Saidanvar AGZAMKHODJAEV 1, Zafar ABDULLAEV 2, Akmal RAKHMATULLAEV 3, Komron KHIDOYATOV 1 and Sarvar ESHONQULOV 1
1) National Children's Medical Center Tashkent, Pediatric urology, Tashkent, UZBEKISTAN - 2) National Children's Medical Center, Pediatric urology, Tashkent, UZBEKISTAN - 3) Tashkent Pediatric Medical Institute, Pediatric surgery, Tashkent, UZBEKISTAN
PURPOSE
We aim to assess the results of endoscopic correction in cases of obstructive ectopic ureteral orifice in children
MATERIAL AND METHODS
From 2021 to 2023, we conducted initial procedures on six patients with obstructive ectopic ureters at the National Children's Medical Center. All these patients presented with unilateral megaureter and febrile urinary tract infections. We excluded patients with bilateral megaureters, primary obstructive megaureter without an ectopic orifice, neurogenic bladder, and posterior urethral valves from this study.
After confirming the ectopic location of the ureteral orifice within the bladder neck via cystoscopy, we performed intravesicalization of the ectopic ureteral orifice using a Holmium laser. This procedure involved creating a neo-orifice by incision the anterior wall of the ureter closer to the trigone
RESULTS
The average age of the patients in the study was 8 months, with a follow-up period of 6 months. Following the endoscopic correction procedure, there was a significant reduction in both the diameter of the ureter and the anterior-posterior diameter of the renal pelvis (p < 0.005). Differential renal function (DRF) improved in 4 out of 6 patients (66.7%), while 2 patients (33.3%) experienced stabilized function and a decrease in episodes of febrile urinary tract infections post-surgery. In one patient who underwent ureteroneocystostomy (UNC) at the age of 12 months, de novo vesicoureteral reflux (VUR) was observed.
CONCLUSIONS
The endoscopic intravesicalization procedure is a minimally invasive and reliable method that can be considered as the first-line surgical treatment for obstructive ectopic ureteral orifices in children
15:56 - 16:01
S12-3 (VP)
Ruben ORTIZ, Beatriz FERNANDEZ-BAUTISTA, Laura BURGOS, Javier ORDOÑEZ and Jose Maria ANGULO
University Hospital Gregorio Marañón, Pediatric Urology, Madrid, SPAIN
PURPOSE
We propose a transurethral endoscopic urinary diversion (EUD) in the initial management of symptomatic obstructive ectopic ureter in infants.
MATERIAL AND METHODS
Twenty obstructive ectopic in 18 patients were initially treated by EUD between 2006 and 2017. Ectopic ureter was always confirmed by cystoscopy. It was indicated in those patients with high suspicion of ureteral ectopia at preoperative imaging scans (US, URO-MR), with urinary tract dilatation worsening and breaking through UTIs despite antibiotic prophylaxis. When ectopic meatus was not found, EUD consisted in the creation of a transurethral neo-orifice (TUNO) performed by needle puncturing of the ureterovesical wall, under fluoroscopic and ultrasound control. If ectopic meatus was identified in the posterior urethra, "intravesicalization procedure" was done opening the urethral-ureteral wall, creating a new ureteral outlet into the bladder. Follow-up protocol included periodical clinical reviews, US, MAG-3 and VCUG scans
RESULTS
Median age of EUD was 3.2 months (0.5-7), with median operating time of 27.5 minutes (12-60) and hospital stay of 1 day (0.5-9). TUNO was performed in 7 cases and "intravesicalization" in 13, with a median follow-up time of 6.5 years (4.2-14.6). Initial renal function was preserved in all cases, with improvement on renal drainage after EUD. Significant postoperative differences were observed in hydronephrosis grade and ureteral diameter (p < 0.005). Postoperative complications were UTI in 7 patients and TUNO stenosis in one, being successfully treated by endoscopic balloon dilation. Secondary VUR was found in 15/20 cases. Definitive treatment was further individualized in each patient after 1 year of life, attending to symptoms and renal function.
CONCLUSIONS
EUD is a feasible and safe less-invasive technique in the initial management of symptomatic obstructive ectopic ureter. It allows an adequate ureteral drainage until the definitive surgery is proposed. It does not invalidate future definitive treatments and other surgical options in case of failure.
16:10 - 16:13
S12-4 (OP)
Camila MORENO BENCARDINO, Joana DOS SANTOS, Rodrigo ROMAO, Joao Pippi SALLE, Michael CHUA, Armando J. LORENZO and Mandy RICKARD
The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
Uretero-ureterostomy (UU) is an attractive option to address upper pole obstructive ureteroceles or ectopic ureters. There are concerns regarding concomitant ipsilateral lower pole reflux (LPR) as a contraindication for this procedure. Herein we aim to evaluate if LPR should impact the decision for UU.
MATERIAL AND METHODS
We retrospectively reviewed the charts of consecutive patients who underwent UU over a 5 year period.We collected demographic variables, findings on preoperative voiding cystourethrogram(VCUG), including LPR, and postoperative outcomes (urinary tract infections [UTIs], use of continuous antibiotic prophylaxis(CAP) and resolution/improvement of hydronephrosis)
RESULTS
We identified 31 UUs with upper pole obstruction (7 ureteroceles, 24 ectopic ureters; 27 females), of which 11 (35%) had documented LPR (5 low grade, 6 high grade). At a follow-up of 28+/-15 months, there was no statistically significant difference in the incidence of postoperative UTIs, complications, duration of prophylaxis, duration of follow-up or need for additional surgeries (p>0.05)(Table).
| No VUR/unknown(n=20) | Lower-pole VUR(n=11) | p | |
| Age baseline(months) | 2+/-1 | 4+/-5 | 0.21 |
|
Ureteroceles Ectopic ureters |
5(71%) 15(63%) |
2(29%) 9(37%) |
1 |
|
Upper-Pole Hydronephrosis(baseline) |
20(100%) | 11(100%) | 1 |
| Upper-Pole SFU grade 3/4(high grade) | 18(90%) | 9(82%) | 0.76 |
| Upper-Pole Ureter max diameter(mm) | 14+/-5 | 13+/-4 | 0.75 |
| Lower-Pole hydronephrosis | 5(25%) | 4(37%) | 0.43 |
| Lower-Pole Ureter max diameter(mm) | 7+/-1 | 9+/-4 | 0.97 |
| Upper-Pole Hydronephrosis(max follow-up) | 17(85%) | 8(72%) | 0.54 |
|
Age at surgery(months): PrimaryUU After ureterocele incision/ureterostomy |
8+/-5 21+/-11 |
8+/-6 8+/-1 |
0.95 0.18 |
| Preoperative VCUG | 18(90%) | 11(100%) | 0.90 |
|
Lower-Pole VUR Grade1-3 Grade4-5 |
5(45.4%) 6(54.5%) |
||
| Postoperative Complications | 3(15%) | 2(18%) | 1 |
| UTI during postoperative surveillance(not immediate 30days) | 3(15%) | 4(36%) | 0.11 |
| CAP Use | 20(100%) | 10(91%) | 0.34 |
| CAP duration | 11+/-6 | 14+/-8 | 0.43 |
| Max Follow-Up(months) | 28+/-15 | 26+/-17 | 0.69 |
CONCLUSIONS
The presence of LPR should not dissuade providers from offering a UU in selected cases with obstructed upper pole pathology.
16:13 - 16:16
S12-5 (OP)
Maria Veronica RODRIGUEZ 1, Paola PEÑA 2, Francisca YANKOVIC 2, Francisco REED 2, Pedro Jose LOPEZ 2, Jose R OVALLE 3, Eliana VARGAS 3, Luis H BRAGA 4 and Juan C PRIETO 5
1) Doctors Hospital at Renaissance, Urology, Edinburg, USA - 2) Hospital Exequiel Gonzalez Cortes, Clinica Alemana and Clinica Santa Maria, Pediatric Urology, Santiago, CHILE - 3) Centro de Urología Pediátrica y Especialidades, Pediatric Urology, Santo Domingo, DOMINICAN REPUBLIC - 4) McMaster University, Pediatric Urology, Hamilton, CANADA - 5) Methodist Children's Hospital and Children's Hospital of San Antonio, Pediatric Urology, San Antonio, USA
PURPOSE
When indicated, ureteroceles and ectopic ureters in duplicated collecting systems can be managed via upper or lower urinary tract approaches, or both.Open ureteroureterostomy(UU) has been described to address these in absence of vesicoureteral reflux (VUR) [Prieto et al.JUrol.2009;181:1844-1850].We report outcomes from multiple centers with long-term follow-ups.
MATERIAL AND METHODS
We retrospectively reviewed 130 children who underwent open inguinal UU for duplicated collecting systems without VUR in institutions from North America, South America, and the Caribbean.Descriptive statistics and univariate analysis were used.
RESULTS
The records of 130 patients were reviewed,64% were female(n=83) with a mean age at operation of 19.5±28.8months.Main presentation at surgery included prenatal hydronephrosis(64%,n=83),febrile urinary tract infections(28%,n=37),urinary incontinence or other(8%,n=10).Mean operative time was 78.8minutes(SD=22.9) in the ureterocele subgroup(n=49) and 90.3minutes(SD=26.4) in those with ectopic ureter(n=81).Mean hospital stay was 1.1±0.7days.In our cohort, 3(2%) presented with Clavien-Dindo I, 6(5%) with grade II, and 2(2%) with IIIb complications.No grade IV/V complications.A double J ureteral stent was used in 59 patients(45%),and a Penrose drain was left in 10(8%). A total of(98%,n=125/127)children showed radiographic improvement or resolution of symptoms with stable ultrasound findings, 3/130 patients were asymptomatic but the follow-up ultrasound was unavailable for review;therefore those were excluded from the analysis.There was no difference in surgical success per subgroups,49/49 patients with ureterocele showed 100% improvement,76/78 with ectopic ureter showed improvement in 97% of the cases.On univariate analysis, surgical success was not influenced by the use of ureteral stents(p= 0.11).Mean follow-up was 28.2±18.7months.
CONCLUSIONS
Open ureteroureterostomy is an optimal alternative for the definitive surgical management of ectopic ureters and ureteroceles without VUR.This multicentric study demonstrates that open UU offers high success rates,low morbidity,short surgical times,and hospital stays with satisfactory aesthetic outcomes.Open UU should be considered worldwide as part of the surgical armamentarium for the management of duplicated collecting systems in children.
16:16 - 16:19
S12-6 (OP)
Camille DUCHESNE, Loriane AQUILINA, Samia LARAQUI, Olivier AZZIS, Benjamin FREMOND, Melodie JURICIC and Alexis P ARNAUD
CHU Rennes, Pediatric Surgery, Rennes, FRANCE
PURPOSE
Polar nephrectomy is the common procedure for renal duplication with complicated nonfunctioning pole, with a 5% risk of lesion of the remaining pole. Ureteral ligation has been described since 2014 as an alternative. We describe the long-term results of our series.
MATERIAL AND METHODS
Bicentric retrospective study between 01/01/2014 and 31/12/2020. Data in median (range).
RESULTS
Twelve ureters were included (7 girls/2 boys): 8 upper poles (1 triplication, 1 bilateral duplication, 4 unilateral duplication) and 4 lower poles (1 bilateral duplication, 2 unilateral duplication). Three girls with ectopic upper ureter presented with urinary incontinence. Two girls with ureterocele had undergone endoscopic incision for recurrent UTI. One girl had recurrent pyelonephritis on a dilated upper moiety. Three patients (2 boys, 1 girl) had a symptomatic refluxing dilated lower pole with recurrent UTI; 1 underwent endoscopic treatment. Preoperative DMSA scan confirmed in all patients the involved nonfunctioning moiety. Ligation was performed at 4.2 years (1.4-16), laparoscopically (11) or retroperitoneoscopically converted to open (1). Four were performed as a day case. At 3 months postoperative, 3 patients experienced recurrent abdominal pain (Clavien Dindo 1) and 5 a dilation increase. One patient developed obstructive pyelonephritis requiring nephrostomy (Clavien Dindo 3b). At 74 months (37-107) of follow-up, 6 ureteral units (50%) (5 patients) required laparoscopic partial nephrectomy (4 robotic and 2 standard laparoscopy), 38 months (2-103) after ligation, for pain (6) +/- pyelonephritis (2). It involved 4 lower pole (100%) and 2 upper pole (25%) tracts.
CONCLUSIONS
Ureteral ligation of nonfunctioning moiety in symptomatic duplex kidney is a feasible technique without risk for the other moiety. However, considering the results in lower poles (100% failure) it should be reserved to upper pole in specific cases.