Pediatr Surg Int. 2025 Jul 13;41(1):208. doi: 10.1007/s00383-025-06123-6.
ABSTRACT
PURPOSE: Ureteropelvic junction obstruction (UPJO) in duplex systems is rare, with laparoscopic pyeloplasty (LP) and laparoscopic pyelo-ureterostomy (LPU) being the main surgical options. However, guidelines for selecting the appropriate procedure based on anatomical variations are lacking. This study evaluates the outcomes of laparoscopic management of duplex UPJO in children, comparing LP and LPU.
METHODS: A retrospective review was conducted on children who underwent surgery for UPJO in duplex systems at two pediatric urology centers over 10 years. Preoperative imaging included ultrasound, diuretic renogram, voiding cystourethrography, and magnetic resonance urography when needed. Retrograde pyelography confirmed anatomy. LP was preferred for lower moiety (LM) UPJO, while LPU was performed for short-segment or hypoplastic incomplete duplex. All children had double J stents for 4-6 weeks. Statistical analysis used t tests and Chi-square tests.
RESULTS: Among 25 children (complete: 11, incomplete: 14), LP was performed in 9/11 complete and 3/14 incomplete cases (p = 0.01). LPU was performed in 11 incomplete cases. The mean operative time was 113 min for LP and 137 min for LPU (p = 0.01). The median hospital stay was 2 days. Two children had postoperative UTIs, and one had early stent expulsion. Outcomes were favorable in all cases.
CONCLUSION: Duplex UPJO consisted of only 3.2% of a large cohort of UPJO from two busy pediatric urology centers. LP was possible in most UPJO in complete duplex, while most UPJO in incomplete duplex had to be managed with LPU. Although LPU was more challenging with longer operative time than LP, both LP and LPU had comparably good results. We strongly recommend intraoperative RGP in all cases of suspected duplex to decide the best surgical option in each case.
PMID:40652413 | DOI:10.1007/s00383-025-06123-6
