Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-up and Outcomes After Side-to-Side Ureterovesicostomy for Primary Obstructive Megaureter in Young Children

No AccessJournal of UrologyPediatric Article11 Apr 2024Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-Up and Outcomes After Side-to-side Ureterovesicostomy for Primary Obstructive Megaureter in Young Children Adree Khondker, Mandy Rickard, Jin Kyu Kim, Julianne Richter, Margarita Chancy, Kay Rivera, Joana Dos Santos, Michael Chua, and Armando J. Lorenzo Adree KhondkerAdree Khondker https://orcid.org/0000-0003-3246-4662 , Mandy RickardMandy Rickard , Jin Kyu KimJin Kyu Kim , Julianne RichterJulianne Richter , Margarita ChancyMargarita Chancy , Kay RiveraKay Rivera , Joana Dos SantosJoana Dos Santos , Michael ChuaMichael Chua , and Armando J. LorenzoArmando J. Lorenzo Corresponding Author: Armando J. Lorenzo, MD, MSc, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada ( ([email protected]) ). View All Author Informationhttps://doi.org/10.1097/JU.0000000000003966AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: To describe long-term outcomes, including urinary tract infections (UTIs) and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructed megaureter (POM). Methods: Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other aetiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up. Results: Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1: 2 (transient urinary retention), and grade 2: 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter and maximum ureteral dilatation. Conclusion: Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for re-operation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsprimary non-refluxing megaureterhydronephrosisrefluxing ureterovesicostomyurinary tract infectionMetrics Author Information Adree Khondker More articles by this author Mandy Rickard More articles by this author Jin Kyu Kim More articles by this author Julianne Richter More articles by this author Margarita Chancy More articles by this author Kay Rivera More articles by this author Joana Dos Santos More articles by this author Michael Chua More articles by this author Armando J. Lorenzo Corresponding Author: Armando J. Lorenzo, MD, MSc, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada ( ([email protected]) ). More articles by this author Expand All Advertisement PDF downloadLoading ...