Selection and clinical effect of surgical approaches for complete duplex kidney with ureterocele in children

Abstract:

Objective：To investigate the surgical approaches for complete duplex kidney with ureterocele in children and their clinical effect. Methods：A retrospective analysis was performed for the clinical data of 60 children with complete duplex kidney and ureterocele who underwent surgical treatment from January 2012 to July 2018. Among these children，34 underwent duplex kidney removal and ureterectomy due to dysplasia of the upper renal segment；among the 26 children without dysplasia of the upper renal segment，5 had severe vesicoureteral reflux（VUR） or stenosis at the end of the ureter without ureterocele and underwent ureteral reimplantation，and 21 underwent transurethral cystoscopic incision and drainage. Surgical outcome was evaluated by clinical manifestations，degree of hydronephrosis，degree of ureterectasia，ureterocele size，VUR，and reoperation rate. Results：All children were followed up after surgery，with a follow-up time of 1-55 months（mean 11.6 months）. Among the 34 children who underwent duplex kidney removal and ureterectomy，5 experienced postoperative urinary tract infection；2 children underwent cystoscopic incision and drainage again，and among the remaining 32 children，6 still had ureterocele on ultrasound，with a significant reduction in ureterocele diameter after surgery（13.2±4.4 mm vs. 26.3±3.9 mm，P=0.004）. Among the 21 children who underwent transurethral cystoscopic incision and drainage，6 experienced postoperative urinary tract infection；3 children underwent duplex kidney removal and ureterectomy again，1 underwent ureterovesical reimplantation，and the remaining 17 children had a significant reduction in the degree of hy－dronephrosis in the upper renal segment（9.9±8.2 mm vs. 24.9±10.8 mm，P=0.000），among whom 8 children still had ureterec－tasia，with a significant reduction in the degree of ureterectasia after surgery（7.0±2.5 mm vs. 10.0±3.3 mm，P=0.007）. Among the 5 children who underwent ureterovesical reimplantation，1 experi－enced urinary tract infection after surgery，no children underwent surgery again，and there was a significant reduction in the degree of hydronephrosis in the upper renal segment after surgery（10.0±2.9 mm vs. 24.2±6.9 mm，P=0.004）. Conclusion：Transurethral cystoscopic incision，duplex kidney removal and ureterectomy，and ureteral reimplantation can be used as an effective treatment for complete duplex kidney with ureterocele. For patients with dysplasia of the upper renal segment，resection of the upper renal segment and ureterectomy are recommended. For patients with well-developed upper renal segment，ureteral reimplantation is recommended for patients with severe VUR or deformity at the end of ureter，and transurethral cystoscopic incision with little trauma is recom－mended for those without other deformities.