Login to Access Video or Poster Abstract: MP61-04
Sources of Funding: None

Introduction

Upper pole nephrectomy has been the traditional surgical management of children with poorly functioning upper pole moieties in duplex renal collecting systems having ureteral ectopia or ureterocele. However, ablative surgery confers a risk of functional loss to the remnant moiety due to vasospasm or vascular injury. We hypothesized that Ipsilateral ureteroureterostomy (IUU) is a safe and feasible approach for the management of these patients, and that residual function in the obstructed upper pole does not affect surgical outcomes.

Methods

All patients who underwent IUU were entered into an IRB approved registry between 2010 to 2016. Only patients with duplex collecting systems were included in the study. Patients were sorted into two groups based on pre-operative imaging: those having < 10% upper pole moiety function (UPMF) and those having ≥10%. Outcomes assessed were post-operative complications (Clavien-Dindo classification), need for secondary surgery and radiological outcomes.

Results

A total of 62 patients underwent IUU between 2010-2016 (43 robotic, 19 open). Study cohort comprised 56 children with ectopia or ureterocele affecting the upper pole in a duplex system, 23 with upper pole moiety function (UPMF) <10% (median function 0%, median age 1.49 years) and 33 with UPMF ≥10% function (median function 15%, median age 0.91 years). Median follow up was 27.4 months and 27.6 months respectively. In both groups, prenatal hydronephrosis was the most common presentation (54.4% and 54.8% respectively) followed by UTI. Mann-Whitney U test comparing the two groups revealed no significant differences in any of the outcomes assessed. Overall, no patient required secondary surgery. In the UPMF <10% group, complete resolution of urinary tract dilation was seen in 85.7% of patients while 14.3% of cases had resolution of hydroureter with near complete resolution of hydronephrosis. In the UPMF ≥10% group these outcomes were 84.6% and 15.4% respectively. Complications occurred in 13.6% of the UPMF<10% group (Clavien grade 2) and 16.1% of the UPMF ≥10% group (Clavien grades 2 and 3).

Conclusions

IUU is a safe, definitive surgical intervention which preserves the renal architecture in children with duplex collecting systems regardless of upper pole function.

Funding

None