ESPU Congress 2017 - Abstract book

CONGRESS OF THE ESPU

08:44–08:47

S4-6 (PP)

DUPLEX SYSTEMS: TOP-DOWN

OR BOTTOM-UP APPROACH?

David KEENE

and Ramnath SUBRAMANIAM

1) Royal Manchester Children’s Hospital, Department of Paediatric Urology, Manchester, UNITED KINGDOM - 2) Leeds

Teaching Hospitals NHS Trust, Department of Paediatric Urology, Leeds, UNITED KINGDOM

PURPOSE

To compare whether a top-down or bottom-up approach results in different likelihoods for further

surgery.

MATERIAL AND METHODS

A prospectively database was maintained for patients undergoing surgery for duplex systems by

a single surgeon between 2003 and 2015. Patients were classified into 2 groups; Group 1 initial

intention for upper approach (heminephroureterectomy-HN) or Group 2 lower approach (bladder

reconstructive surgery-BRS). The requirement for further surgery was recorded; endoscopic inci-

sion (EI), bladder reconstructive surgery (BRS), endoscopic correction of reflux (ECR), hemineph-

roureterectomy (HN). Indications for initial and subsequent surgery included urinary tract infection,

VUJ obstruction and incontinence. Endoscopic incision was not performed for patients with an

asymptomatic ureterocele. Fisher’s exact test with a 2-tail p value <0.05 was used.

RESULTS

79 patients underwent surgery for duplex systems. 39 patients had HN initially (Group 1) and

40 patients had BRS initially (Group 2).

Further surgery was performed in 28% of patients from Group 1 (8 BRS, 5 EI) vs 5% of patients from

Group 2 (1 redo BRS, 1 ECR). Significantly less additional surgical procedures were performed after

BRS compared to HN (p=0.006). The presence of either reflux or ureterocele increases the chances

of further surgery in those patients who had HN initially compared to BRS (p=0.02, p=0.002).

Group

1-Heminephroureterectomy 2–Bladder reconstructive surgery

Number of patients

Mean age at surgery (years)

3.8(0.8-17.4)

4.7(0.7-16.6)

Mean duration follow-up (years)

9.6(1-13)

3.4(1-7.3)

Further Surgery

11(28%)*

2(5%)*

Risk groups

Dilating reflux grade

3-5

9/15 patients (40%)**

1/18 patients (6%)**

Ureterocele

10/22 patients (45%)***

2/20 patients (10%)***

Both reflux+

ureterocele

5/7 patients (71%)

1/2 patients (50%)

* p=0.006,**p=0.002,***p=0.02

CONCLUSIONS

Bladder reconstructive surgery (BRS) reduces the requirement for further surgery compared to

heminephroureterectomy (HN) in symptomatic patients with a duplex kidney and either dilating

vesicoureteric reflux or ureterocele.

08:47–08:56

Discussion