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19–22 APRIL, 2017, BARCELONA, SPAIN
15:20–15:23
S17-7 (PP)
SIDE-TO-SIDE REFLUXING NON-DISMEMBERED
URETEROCYSTOTOMY: KEEPING AN INTACT
URETEROVESICAL JUNCTION, SIMPLIFYING THE KAEFER
TECHNIQUE AS A STRATEGY TO ADDRESS OBSTRUCTED
MEGAURETERS IN CHILDREN
Fahad A. ALYAMI
1
, Martin A. KOYLE
2
, Paul R. BOWLIN
3
, Joseph M. GLEASON
4
, Luis
H. BRAGA
5
and Armando J. LORENZO
6
1) King Saud University, King Saud University Medical City, Department of Surgery, Division of Urology, Riyadh,
SAUDI ARABIA - 2) University of Toronto, Department Of Surgery, Division of Urology, Toronto, CANADA - 3) University
of Kansas Medical Center and Children Mercy Hospital, Department Of Urology, Kansas, USA - 4) University
of Tennessee Health Science Center and Le Bonheur Children’s Hospital, Department of Urology, Tennessee, USA -
5) McMaster University, McMaster Children’s Hospital, Department of Surgery, Division of Urology, Hamilton, CANADA
- 6) University of Toronto, Department of Surgery, Division of Urology, Toronto, CANADA
PURPOSE
A non-refluxing megaureter (NRMU) is a relatively common etiology of antenatal hydronephrosis.
Although surveillance and non-operative management is warranted for the majority of cases, early
surgical intervention should be selectively considered in some. Currently accepted options include
nephroureterectomy, tapered non-refluxing ureteral reimplantation, cutaneous ureterostomy and
later reimplantation, endoscopic dilation with temporary stenting, and dismembered refluxing ure-
teric reimplantation in an end-to-end fashion (with subsequent reimplantation). Herein we describe
our experience with a modified side-to-side refluxing ureterocystotomy (UC) as a simple alternative
in the management for NRMU.
MATERIAL AND METHODS
Between February 2012 andAugust 2016, 32 consecutive side-to-side refluxing UCwere performed.
Demographics, surgical indications, complications, need for further interventions, and change in
hydronephrosis were captured. The procedure was performed through a small inguinal incision,
with a refluxing side-to-side anastomosis between the distal ureter and the ipsilateral bladder wall.
RESULTS
Mean age at time of surgery was 3.7 months (0-33), 25 (78%) patients were males. Patients were
initially identified based on the presence of ANH (32) or symptoms (10) and followed with US every
3 months and renal scans accordingly. Unilateral procedures were done in 29 patients. The pro-
cedure was conducted for primary NRMU in 27 patients and as salvage procedure for obstruction
after a common sheath ureteral reimplantation in one child with a duplex system. Average follow-up
was 28 months. At time of most recent evaluation, most children demonstrated significant improve-
ment in dilation (86%). To date, 4 patients have required further procedures, including 2 ureteral
reimplantations due to recurrent infections.
CONCLUSIONS
Our results show that side-to-side refluxing UC is a simple, minimally invasive alternative for
surgical management of primary NRMU. Despite the tradeoff of relieving obstruction and creating
reflux, it can be considered a potentially definitive intervention in patients who remain infection-free.
Long-term assessment of this technique is required.