Laparoscopic ureteroureterostomy for the treatment of complete pediatric renal ureteral duplication: Does anastomotic site matter?

OBJECTIVE

To compare the efficacy of laparoscopic proximal versus distal ureteroureterostomy in the treatment of complete renal-ureteral duplication malformation in children.

METHOD: This retrospective study included 72 pediatric patients diagnosed with complete renal-ureteral duplication malformation at the First Affiliated Hospital of Zhengzhou University between January 2014 and December 2021. Diagnosis was confirmed through various imaging studies, including ultrasound, diuretic renography, CT urography (CTU), magnetic resonance urography (MRU), and voiding cystourethrography (VCUG). Patients were divided based on surgical technique into the proximal laparoscopic ureteroureterostomy group (PLUU, n = 30) and the distal laparoscopic ureteroureterostomy group (DLUU, n = 42). Surgical duration, intraoperative blood loss, postoperative drainage time, length of hospital stay, postoperative complications, changes in anteroposterior diameter (APD) of the affected upper renal pelvis, ureteral diameter (UD), renal cortical thickness (RCT), and differential renal function (DRF) were compared between the two groups.

RESULT: The DLUU group exhibited significantly less intraoperative blood loss (t = 2.125, P = 0.032) and shorter postoperative drainage time (t = 2.231, P = 0.025) compared to the PLUU group. However, there were no significant differences in surgical duration (t = 1.365, P = 0.194) or length of hospital stay (t = 1.543, P = 0.132) between the two groups. The PLUU group experienced three long-term complications (one case of anastomotic stricture, one case of new-onset vesicoureteral reflux, and one case of stump syndrome), while the DLUU group had one case of anastomotic stricture; this difference was not statistically significant (X2 = 0.756, P = 0.384). Both groups demonstrated trends towards improvement in APD, UD, RCT, and DRF postoperatively. Further analysis revealed no statistically significant differences in the change values for APD (ΔAPD: t = -1.048, P = 0.286), UD (ΔUD: t = 1.562, P = 0.124), RCT (ΔRCT: t = 0.927, P = 0.306), or DRF (ΔDRF: Z = 1.589, P = 0.072) between the two groups.

CONCLUSION

Both PLUU and DLUU are safe and effective treatments for complete renal-ureteral duplication malformation in children. DLUU is associated with less intraoperative blood loss and shorter postoperative drainage times compared to PLUU.