Ureterocalicostomy in children: 12 years experience in a single centre

• Published in: BJU international 2011-08, Vol.108 (3), p.434-438
• Main Authors: Radford, Anna R., Thomas, David F. M., Subramaniam, Ramnath
• Format: Article
• Language: English
• Subjects: Adolescent; Anastomosis, Surgical - methods; Biological and medical sciences; Child; Child, Preschool; children; Female; Humans; Kidney - abnormalities; Kidney Calices - surgery; Male; Medical sciences; Nephrology. Urinary tract diseases; pelvi‐ureteric junction obstruction; Postoperative Care - methods; pyeloplasty; Stents; Treatment Outcome; Ultrasonography; Ureter - surgery; Ureteral Obstruction - diagnostic imaging; Ureteral Obstruction - etiology; Ureteral Obstruction - surgery; ureterocalicostomy; Ureteroscopy - methods; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09925.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Since 1947 ureterocalicostomy has been a recognised option in the treatment of obstructive systems either as a primary or salvage procedure, however few series specific to the paediatric patient exist. This 12 year review of 13 cases at one tertiary centre demonstrates ureterocalicostomy to be a versatile, reliable means of relieving obstruction for a variety of indications; horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. OBJECTIVE •  To document the outcome of ureterocalicostomy in children. PATIENTS AND METHODS •  The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively. •  Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi‐ureteric junction (PUJ) obstruction. •  In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty. •  An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically‐assisted technique. RESULTS •  Mean age at operation was 9.3 years and the mean (range) duration of follow‐up was 2.6 (0.3–7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging. •  However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow‐up to 3 years. CONCLUSIONS •  Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. •  Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.