Stanislaw Warchol1*, Teresa Dudek-Warchol1, Przemyslaw Bombinski2, Krzysztof Toth3, Agnieszka Szmigielska4 and Grazyna Krzemien4
1Department of Pediatric Surgery and Urology, Medical University of Warsaw, Poland
2Department of Pediatric Radiology, Medical University of Warsaw, Poland
3Nuclear Medicine Laboratory Nukleomed, Poland
4Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
Purpose: The management of primary obstructive megaureters has evolved regarding time of operative intervention, type of intervention as well as one stage or two stage operative treatment (cutaneous ureterostomy and then ureteral reimplantation or only ureteral reimplantation), open or laparoscopic approach or even robotic. There is no standard approach and various operative techniques and modes of treatment are described. The purpose of this study was to present experience with two-stage operative treatment of primary obstructive megaureter in children.
Materials and Methods: Over the last 10 years 17 children (14 boys and 3 girls) underwent two-stage operative treatment of primary obstructive megaureter. The first stage of surgical treatment included creation of Williams ureterocutaneostomy. The indications for ureterocutaneostomy were as follows: progressive dilatation of ureter as estimated ultrasonographically, together with progressive deterioration of split renal function with significant obstruction as estimated on radionuclide scan. The second stage of operative treatment included simultaneous Politano-Leadbetter ureteral reimplantation (in 8 with additional remodeling of the ureter using Kalicinski plication) and closure of ureterocutaneostomy.
Results: In all 17 children follow-up studies (ultrasound and radionuclide examinations) showed gradually decrease of dilatation of urinary tract together with constant improvement in renal function and renal drainage. In 5 out 17 children (all without plication) high grade vesicoureteral reflux was noted postoperatively. In 2 repeated ureteroneocystotomy was done, in 3 endoscopic correction was performed resulting in reflux resolution. Conclusions: Our experience with staged method of operative treatment of primary obstructive megaureter has been favorable. Surgical intervention in selected cases of megaureter still is valuable option.
Primary obstructive megaureter, Ureteral reimplantation, Ureteral folding; Ureteroneocystotomy
Warchol S, Dudek-Warchol T, Bombinski P, Toth K, Szmigielska A, Krzemien G. Two-Stage Operative Treatment of Primary Obstructive Megaureter in Children. Ann Urol Res. 2018; 1(2): 1010.