The management of children with complete ureteric duplication: selective use of uretero-ureterostomy as a primary and salvage procedure

Objective To determine the optimum management of duplex urinary tracts with refluxing or obstructed units. Patients and methods Sixty-three children (19 boys and 44 girls) with complete duplex-system anomalies (84 duplex system units) who underwent corrective surgery by one surgeon (H.C.) between March 1983 and June 1997 were reviewed, analysing their diagnosis and treatment. Results Most children had presented with urinary tract infection; a ureterocele was found in 26 renal units, reflux in 12 and a combined anomaly in 18. Ectopic insertion of the ureter causing incontinence was found in six and ureteric obstruction in nine ureteric units. Patients were managed so that whenever possible, functional renal tissue was preserved; thus surgical strategies were basically staged, conservative, and planned preoperatively on the basis of renal function. Initial surgery was undertaken in 71 units (all patients; ureterocele incision in 12, upper pole nephrectomy in 30, ureteric reimplantation in 14, uretero-ureterostomy in 13 and others in two). The median (range) follow-up was 7.6 (2.1-16) years. Secondary procedures were undertaken in 24 units (34%); ureterocele incision (11 of 12 units) was the most common procedure of additional surgery, followed by ureteric reimplantation (six of 27 units), upper pole nephrectomy (eight of 37 units) and uretero-ureterostomy (two of 18 units). Conclusions Uretero-ureterostomy was the most successful nephron-sparing additional operation. When the upper pole is salvageable, uretero-ureterostomy may be the preferred alternative for managing complete duplex system anomalies.