J Urol. 2024 Apr 11:101097JU0000000000003966. doi: 10.1097/JU.0000000000003966. Online ahead of print.
ABSTRACT
PURPOSE: To describe long-term outcomes, including urinary tract infections (UTIs) and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructed megaureter (POM).
METHODS: Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other aetiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up.
RESULTS: Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1: 2 (transient urinary retention), and grade 2: 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter and maximum ureteral dilatation.
CONCLUSION: Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for re-operation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy.
PMID:38603645 | DOI:10.1097/JU.0000000000003966
