Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age

Jude, Emily; Deshpande, Aniruddh V.; Barker, Andrew; Khosa, Japinder; Samnakay, Naeem

doi:10.1016/j.jpurol.2016.09.009

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…Only 8 of the 26 ureters (14 obstructing and 12 refluxing ureters) were tapered. Comparative studies presented by Ben-Meir et al [21], and later by Jude et al [22] support reimplantation without tailoring in a selected group of obstructed megaureters with a similar success rate to tailoring even in infants under 1 year of age.…”

Section: Discussionmentioning

confidence: 80%

Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study

et al. 2019

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Introduction The conservative management of the primary obstructive megaureter (POM) is considered to be the optimal option in patients with an adequate ureteral drainage. However, in cases of clinically significant obstruction, massive hydroureteronephrosis, decline of renal function and breakthrough febrile urinary tract infection, the surgical intervention is recommended. At present an open surgery is the standard practice for the primary megaureter in children. Recently, less invasive alternatives have been reported. Objectives We aimed to perform the multi-institutional study to assess the effectiveness of the laparoscopic extravesical transverse ureteral reimplantation (LETUR) in children with megaureter. Study design This is a retrospective study of the results of the LETUR in seventy-six children with megaureter (78 ureters). There were 50 obstructive and 28 refluxing megaureters. The data was collected from four paediatric centers between 2011 and 2017. Results Of the 78 megaureters, in 31 (39.7%) anatomy was classified as complex, and included 15 ureteral duplications, 7 bladder diverticulums, 6 post-previous anti-reflux surgery, and 3 previously diverted ureters. Of the 78 ureters, 34 were tailored, and 44 ureters were reimplanted without tailoring. There were 8 (10.5%) postoperative complications. One patient demonstrated temporary ureteral obstruction. Overall radiographic success rate (no obstruction, no VUR) was seen in 69 of the 78 (88.5%) ureters that were studied. Neither type of reimplantation (tailored or non-tailored), nor age of patients influenced the success rate of LETUR. Conclusion We believe that the laparoscopic extravesical transverse ureteral reimplantation is a safe and feasible option when the ureteral reimplantation is indicated.

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Section: Discussionmentioning

confidence: 80%

Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study

et al. 2019

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“…Jude et al reported their experience with intravesical ureteral reimplantation for primary obstructed megaureter in infants under 1 year of age. 11 The mean postoperative follow-up was 6.2 years, but asymptomatic children with postoperative resolution or improvement of hydroureteronephrosis on US did not have a routine postoperative MAG-3 scans. Therefore, no information was available regarding the renal function of these patients around puberty.…”

Section: Discussionmentioning

confidence: 93%

“…functioning kidneys. 11,12 However, there is a limited data on the long-term results of those children, especially when they reach puberty. Renal function after reimplantation must accommodate the numerous changes in the pediatric urinary tract that occur along with child development.…”

Section: Introductionmentioning

confidence: 99%

Does Renal Function Remain Stable after Puberty in Children who underwent Ureteral Reimplantation due to Ureterovesical Junction Obstruction?

et al. 2020

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Introduction Ureteric reimplantation due to ureterovesical junction (UVJ) obstruction enjoys high success in the short term. However, renal function after reimplantation must accommodate the numerous changes in the pediatric urinary tract that occur along with child development that may theoretically cause an occult loss of renal function. The purpose of this study was to evaluate whether improved renal function after ureter reimplantation for antenatal diagnosed UVJ obstruction remains stable after puberty. Materials and Methods Twenty-one children who underwent open reimplantation using Politano–Leadbetter technique were followed until they completed puberty. Mean age at surgery was 14.3 months (range: 3–60 months). Five (23.8%) of 21 children had right hydronephrosis, 13 (61.9%) had left hydronephrosis, and 3 (14.3%) had bilateral hydronephrosis. The Society for Fetal Urology (SFU) level of the hydronephrosis was 3 (47.6%) in 10 children and 4 (52.4%) in remaining 11. Fourteen (66.6%) patients had poor renal function upon surgery and the remaining seven (33.4%) patients had moderate renal function. The mean renal function upon operation was 28 ± 4.3 (mean ± standard deviation [SD]). Results Reimplantation led to the increase in the RRF in the short-term period from 28 ± 4.3% prior to the surgery to 36.4 ± 5% (p < 0.001) in all patients and remains stable 35 ± 5% after puberty in all the reviewed patients. Conclusion Our data demonstrate for the first time that successful ureteral reimplantation following antenatal diagnosis of UVJ obstruction is associated with an improvement in renal function, not only during short- and midterm follow-up but also allows preserving the renal function throughout the puberty period.

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“…Compared with the intravesical tunneled ureteric reimplantation technique, PBH facilitates easier preparation of a wide and long submucosal tunnel and reduces difficulty in performing anastomosis of the bulky mass of the ureter to the bladder. In addition, the duration of postoperative ureteric stent retention in cases of resection tapering is reported to be 1 month for JJ stents [3,31] and 1-2 weeks for external drainage stents [2,3,31,35]. For all four patients in whom ureteric folding or ureteric plication was performed in the present study, the external drainage stent could be removed within 1 week postoperatively.…”

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confidence: 75%

Long‐term safety and efficacy of psoas bladder hitch in infants aged <12 months with unilateral obstructive megaureter

et al. 2020

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Objective To determine the long‐term safety and efficacy of ureteric reimplantation with psoas bladder hitch (PBH) in patients aged <12 months with unilateral obstructive megaureter (OM). Patients and Methods We retrospectively compared a group of patients aged <12 months (study group) with an group of patients aged ≥12 months (comparison group), who underwent PBH for OM between September 2007 and April 2017, in terms of preoperative patient characteristics, intra‐ and peri‐operative results, and postoperative results. Results The study group comprised seven infants, five boys and two girls. The median (range) age at the time of PBH was 3 (2–8) months; OM was detected by ultrasonography during the fetal period. The left side was affected in four infants and the right side in three. Four infants had primary OM (POM). In all three infants who had ectopic OM in the complete double renal pelvis and ureter, the OM involved the ureter from the upper half of the kidney. The median (range) follow‐up period after PBH was 45 (33–129) months. Comparison of the two groups showed no significant difference in terms of surgical time (P = 0.948) and length of hospital stay (P = 0.125). In both groups, hydroureteronephrosis improved postoperatively in all patients. There was no significant difference between the two groups in terms of postoperative complications, such as vesico‐ureteric reflux, febrile urinary tract infection and deterioration of ipsilateral renal function. Notably, no patient underwent reoperation in either group. Conclusion Psoas bladder hitch for unilateral OM including POM appears to be safe and effective in the long term for patients aged <12 months and for those aged ≥12 months. Although not routinely recommended, PBH appears to be a viable option for selected infants with POM.

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Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age

Cited by 17 publications

References 24 publications

Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study

Laparoscopic extravesical transverse ureteral reimplantation for megaureter in children: results from a multi-institutional study

Does Renal Function Remain Stable after Puberty in Children who underwent Ureteral Reimplantation due to Ureterovesical Junction Obstruction?

Long‐term safety and efficacy of psoas bladder hitch in infants aged <12 months with unilateral obstructive megaureter

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