Journal List > Korean J Urol > v.48(11) > 1004821

TOOLS
Kim, Lee, and Han: Postoperative Outcome of the Upper Pole Kidney with a Complete Ureteral Duplication and Complicated with Ureterocele or Ectopic Ureter after Pyeloureterostomy
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(11): 1155-1160.

Published online: 30 November 2007

DOI: https://doi.org/10.4111/kju.2007.48.11.1155

Postoperative Outcome of the Upper Pole Kidney with a Complete Ureteral Duplication and Complicated with Ureterocele or Ectopic Ureter after Pyeloureterostomy

Hyung Joon Kim, Hye Young Lee, Sang Won Han

Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (swhan@yumc.yonsei.ac.kr)

Received 14 May 2007       Accepted 11 September 2007

Copyright © 2007 The Korean Urological Association

Abstract

Purpose

Non conservative treatment such as heminephrectomy is considered the treatment of choice when the upper pole kidney in children with a complete ureteral duplication complicated with ureterocele or ectopic ureter is nonfunctional. The postoperative outcome of the upper pole kidney with a complete ureteral duplication after pyeloureterostomy was evaluated, and we focused on those children with undetected functions on the upper pole kidney before surgery.

Materials and Methods

Between May 2002 and March 2006, we evaluated 28 children, 10 boys and 18 girls, who had undergone pyeloureterostomy for a complete ureteral duplication that was complicated with ureterocele or ectoplic ureter. Their mean age was 12.3 months. Ultrasound, 99mTc-dimercaptosuccinic acid (DMSA) scanning and voiding cystourethrography (VCUG) were performed preoperatively. The clinical courses were followed up with ultrasound at 1, 3, 6 and 12 months, and DMSA scanning was done between 6 and 12 months after surgery. The median follow-up period was 21.5 months.

Results

Among the 12 children with cortical thinning seen on ultrasound, 10 showed thickening of the renal cortex within 12 months. All 16 children with Grade III or less hydronephrosis on the upper pole kidney were downgraded, and 10 out of them showed complete resolution or Grade I hydronephrosis within 6 months. 4 cases with no visible photon uptake at the upper pole kidney preoperatively showed hot uptakes at the defective spot between 6 to 12 months after pyeloureterostomy. 5 out of 28 children had urinary tract infection (UTI) within 3 months after surgery; however, this was easily controlled with oral antibiotics.

Conclusions

The function of the upper pole kidney is recovered within 1 year after pyeloureterostomy in most of the cases with a complete ureteral duplication, regardless of the severity of hydronephrosis at the upper pole kidney. Pyeloureterostomy can be an alternative treatment modality for treating a complete ureteral duplication that's complicated with ureterocele or ectopic ureter due to pyeloureterostomy's lower morbidity compared to non-conservative surgery such as heminephrecotmy.

Keywords: Kidney, Ureter, Surgery, Ultrasonography, Radioisotope renography

Figures and Tables

Fig. 1
Resolution of severe hydronephrosis on the upper pole kidney after pyeloureterostomy (A) 6 months postoperative follow-up ultrasound of a child with intravesical ureterocele (B) 12 months postoperative follow-up ultrasound of a child with ectopic ureterocele.
kju-48-1155-g001
Fig. 2
Appearance of photon uptake on the upper pole kidney after pyeloureterostomy (A) 12 months postoperative follow-up 99mTc-dimercaptosuccinic acid (DMSA) scan of a child with intravesical ureterocele (B) 6 months postoperative follow-up DMSA scan of child with ectopic ureter.
kju-48-1155-g002
Table 1
Clinical course of the hydronephrosis grade of the upper pole kidney after pyeloureterostomy
kju-48-1155-i001

References

1. Choi HS, Chin OH, Han SW. First-line treatment modality in children with complete duplicating system complicated with ureterocele or ectopic ureter: ureteropyelostomy. Korean J Urol. 2002. 43:667–671.
2. Ko WJ, Hong CH, Han SW. Duplicated collecting system with lower pole ureteropelvic junction obstruction. Yonsei Med J. 2001. 42:553–557.
3. Shankar KR, Vishwanath N, Rickwood AM. Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly. J Urol. 2001. 165:1226–1228.
4. Han MY, Gibbons MD, Belman AB, Pohl HG, Majd M, Rushton HG. Indications for nonoperative management of ureteroceles. J Urol. 2005. 174:1652–1655.
5. Piaggio L, Franc-Guimond J, Figueroa TE, Barthold JS, Gonzalez R. Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children. J Urol. 2006. 175:2269–2273.
6. Gran CD, Kropp BP, Cheng EY, Kropp KA. Primary lower urinary tract reconstruction for nonfunctioning renal moieties associated with obstructing ureteroceles. J Urol. 2005. 173:198–201.
7. Mandell J, Colodny AH, Lebowitz R, Bauer SB, Retik AB. Ureteroceles in infants and children. J Urol. 1980. 123:921–926.
8. Caldamone AA, Snyder HM 3rd, Duckett JW. Ureteroceles in children: followup of management with upper tract approach. J Urol. 1984. 131:1130–1132.
9. Blyth B, Passerini-Glazel G, Camuffo C, Snyder HM 3rd, Duckett JW. Endoscopic incision of ureteroceles: intravesical versus ectopic. J Urol. 1993. 149:556–559.
10. Shekarriz B, Upadhyay J, Fleming P, Gonzalez R, Barthold JS. Long-term outcome based on the initial surgical approach to ureterocele. J Urol. 1999. 162:1072–1076.
11. Kim HT, Yoo ES, Chung SK. Management of upper moiety in complete duplex system. Korean J Urol. 2005. 46:7–13.
TOOLS
Similar articles