Should the presence of ipsilateral lower pole vesicoureteral reflux impact the decision to offer a uretero-ureterostomy for children with duplication anomalies?

OBJECTIVE

To evaluate whether the presence of ipsilateral lower pole vesicoureteral reflux (iLPR) should influence surgical decision-making in cases of associated upper pole (UP) pathology otherwise amenable to a uretero-ureterostomy (UU).

METHODS

We conducted a single-institution retrospective review of 41 pediatric patients with duplex system anomalies who underwent UU over five years. Patients were segregated into two groups: those without evidence of iLPR (including those with unknown reflux status), and those with documented iLPR. Primary outcomes included postoperative urinary tract infections (UTIs), surgical complications, and improvement/resolution of hydronephrosis.

RESULTS

Of 41 patients, 11 had confirmed iLPR. Demographics, preoperative ultrasound findings, and clinical presentation were comparable between groups. We followed a stent-free, radiation-free, open surgical technique, with most patients discharged within 24 hours. Complication rates-including UTIs, infected ureteral stumps, and anastomotic leaks-were similar between groups and not statistically significant. During postoperative surveillance, UTIs occurred in 21 % of the no/unknown-iLPR group and 36 % of the LPR group (p = 0.55), though most were isolated events. UP hydronephrosis improved or resolved in over 90 % of cases, with no significant difference between groups.

CONCLUSION

UU is a safe and effective surgical option for managing duplex UP anomalies, even in the presence of reflux. Our findings challenge historical exclusion of iLPR patients from UU consideration and suggest that routine preoperative VCUGs may not be necessary, particularly in the absence of other indications for obtaining a cystogram.