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Complications after common sheath reimplantation in pediatric patients with complicated duplex system

 Yong Seung Lee  ;  Young Jae Im  ;  Sang Hee Shin  ;  Rosito T. Bascuna  ;  Ji Yong Ha  ;  Sang Won Han 
 UROLOGY, Vol.85(2) : 457-462, 2015 
Journal Title
Issue Date
Algorithms ; Cohort Studies ; Female ; Humans ; Infant ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Ureter/abnormalities* ; Ureter/surgery* ; Ureterocele/complications* ; Ureterocele/surgery* ; Urinary Incontinence/epidemiology ; Urinary Incontinence/etiology ; Urologic Surgical Procedures/methods
OBJECTIVE: To report our experience of common sheath reimplantation (CSR) for ectopic ureterocele (EU) combined with ureteral duplication, describing success rates and postoperative complications, along with risk factors for developing postoperative incontinence. METHODS: When the upper tract approach is not indicated in patients with EU, a bladder-level approach, involving either CSR or total reconstruction, is the remaining option. However, concerns exist about the high morbidity of bladder-level approaches. We retrospectively examined the postoperative results of 39 patients who underwent CSR between January 2001 and December 2012. Risk factors for the development of postoperative incontinence and decreases in differential renal function (DRF) were additionally analyzed. RESULTS: The median age at operation was 16.5 months. After CSR, upper urinary tract dilatation decreased in 36 patients (92.3%). During a median follow-up of 75.9 months, an additional operation was required in 7 patients (17.9%). Postoperative incontinence developed in 3 patients (7.7%). Median preoperative DRF was significantly lower in the postoperative incontinence group (P = .004). DRF decreased postoperatively in 5 of 36 patients (13.9%). No preoperative factors were related to the decrease in DRF. No patient developed hypertension or proteinuria. CONCLUSION: CSR decompressed the upper urinary tract effectively in our EU patients. Postoperative incontinence does not seem to be related to operation factors, but with preoperative DRF. When the upper tract approach is not indicated, CSR is a reasonable alternative. Total reconstruction is unnecessary as the remnant upper pole kidney after CSR does not lead to complications.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Bascuna, Rosito T.(알비바스쿤야)
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Ha, Ji Yong(하지용)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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