V3-08: Inguinal Ureteroureterostomy for Management of Non-Refluxing Double Collecting System Pathology and Mid-ureteral Strictures in Children
VideoIntroductions and Objectives
Ureteroceles and ectopic ureters in duplicated collecting systems can be managed via upper or lower urinary tract surgical approaches, or a combination of both. Ureteroureterostomy (UU) can be performed via traditional open, laparoscopic or robotic-assisted techniques. A series of ureteroureterostomy via inguinal incision was recently published1; the surgeries were performed in patients with ureteroceles or ectopic ureters without associated lower pole (LP) vesicoureteral reflux (VUR). We have expanded the application of inguinal UU to manage midureteral strictures in small children.
We present a video of the inguinal UU surgical technique in a patient with hydroureteronephrosis secondary to a right ectopic ureter in a double collecting system. Furthermore, the technique was applied to a 3-month old female with a right midureteral stricture causing decreased ipsilateral differential renal function.
After making a 2.5-cm inguinal incision, the anterior and posterior walls of the inguinal canal were opened to access the retroperitoneum. The duplicated ureters were identified and dissected distally to the common sheath. The dilated upper pole (UP) ureter was transected and the distal stump ligated using 3-0 absorbable sutures. The diameter of the UP ureter was measured, and the LP ureter was incised according to the UP ureter dimension. End to side UU was accomplished using interrupted 6-0 absorbable sutures. The inguinal incision was closed in layers after ensuring the lack of a urinary leak across the anastomosis. Improved hydronephrosis and no complications have been reported so far.
Inguinal UU is an excellent alternative for the definitive surgical management of ectopic ureters and ureteroceles without ipsilateral LP VUR. The technique is also feasible to treat mid-ureteral strictures in small children. Inguinal UU has significant advantages over other surgical techniques including shorter surgical times and hospital stay, lower morbidity, and improved cosmetic results. Inguinal UU should be promoted to become part of the surgical armamentarium of pediatric urologists. 1 Prieto et al. Ureteroureterostomy Via Inguinal Incision For Ectopic Ureters and Ureteroceles Without Ipsilateral Lower Pole Reflux. J Urol. 2009; 181:1844-1850.