Abstract
Background
Ureteric ectopia is a pediatric urinary incontinence cause in girls. It is traditionally managed through hemi-nephrectomy or uretero-ureterostomy, which have the potential for complications including anastomotic stricture, leak, bleeding, and de-vascularization of the functioning renal moiety. Laparoscopic ureteric clipping has been shown to be a good alternative but has not been widely adopted yet. We provide our experience with this technique.
Methods
We retrospectively reviewed the data of 6 patients who underwent laparoscopic clipping of ectopic ureter between 2014 and 2019. We collected the following information: clinical presentation, preoperative and postoperative imaging, age at presentation, age at surgery, operative time, complications, length of stay, length of follow-up, as well as continence outcomes.
Results
Five patients were diagnosed with a duplex system associated with an ectopic upper pole ureter. One patient was noted to have a non-functional kidney associated with an ectopic ureter. Median age at presentation was 5 years (6 weeks-9 years), while at surgery was 8 years (2–13 years). Four patients were referred for incontinence, 1 was referred for antenatal hydronephrosis, 1 presented with urosepsis. The preoperative renal pelvis anteroposterior diameter (APD) was 8.60 cm (median) (6.80–8.70 cm). At the post-operative follow-up, the APD increased to median 9.1 cm (6.80–11.50 cm). Median operative time was 91 min (42–60 min). Complications were seen in only one patient who developed an immediate postoperative urinary tract infection (UTI). Five patients were discharged home the same day of the surgery, while the patient who developed UTI went home on post-operative day 3. Median follow-up was 33 months (22–72 months). Currently, all patients have achieved daytime urinary continence. No patient had UTI during the follow-up period.
Conclusion
Laparoscopic ureteric clipping of the ectopic ureter appears to be a valid alternative to extirpative or reconstructive procedures. Follow-up shows an increase in hydronephrosis without any consequence for the patients. Further studies are necessary to reinforce these observations.
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References
Ahmed S, Morris LL, Byard RW (1992) Ectopic ureter with complete ureteric duplication in the female child. J Pediatr Surg 27:1455–1460. https://doi.org/10.1016/0022-3468(92)90199-H
Hanson GR, Gatti JM, Gittes GK, Murphy JP (2007) Diagnosis of ectopic ureter as a cause of urinary incontinence. J Pediatr Urol 3:53–57. https://doi.org/10.1016/j.jpurol.2005.06.009
Cezarino BN, Lopes RI, Oliveira LM et al (2015) Diagnostic work-up and laparoscopic correction of an ectopic ureter. J Pediatr Urol 11:285–286. https://doi.org/10.1016/j.jpurol.2015.04.028
Wang DS, Bird VG, Cooper CS et al (2004) Laparoscopic upper pole heminephrectomy for ectopic ureter: initial experience. Can J Urol 11:2141–2145
Ballouhey Q, Binet A, Clermidi P et al (2017) Partial nephrectomy for small children: Robot-assisted versus open surgery. Int J Urol 24:855–860. https://doi.org/10.1111/iju.13466
Storm DW, Modi A, Jayanthi VR (2011) Laparoscopic ipsilateral ureteroureterostomy in the management of ureteral ectopia in infants and children. J Pediatr Urol 7:529–533. https://doi.org/10.1016/j.jpurol.2010.08.004
Goh BKP, Dean PG, Cosio FG et al (2011) Bilateral native ureteral ligation without nephrectomy in the management of kidney transplant recipients with native proteinuria. Am J Transplant 11:2747–2750. https://doi.org/10.1111/j.1600-6143.2011.03721.x
Khoubehi B, Williams G (2003) Re: Ligation of the native ureter in renal transplantation [1]. J Urol 169:292. https://doi.org/10.1016/S0022-5347(05)64100-6
Romao RLP, Figueroa V, Pippi Salle JL et al (2014) Laparoscopic ureteral ligation (clipping): A novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties. J Pediatr Urol 10:1089–1094. https://doi.org/10.1016/j.jpurol.2014.04.008
Lopes RI, Fernandez N, Koyle MA et al (2018) Clinical outcomes of the upper urinary tract after ureteral clipping for treatment of low functioning or nonfunctioning renal moieties. J Urol 199:558–564. https://doi.org/10.1016/j.juro.2017.09.080
Canning DA (2016) Re: Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties editorial comment. J Urol 195:168–170. https://doi.org/10.1016/j.juro.2015.10.027
Michaud JE, Akhavan A (2017) Upper pole heminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters. Curr Urol Rep. https://doi.org/10.1007/s11934-017-0664-0
Torino G, Innocenzi M, Mele E et al (2016) Comparison of native ureteral ligation and open nephrectomy for pediatric renal transplantation. J Urol 196:875–880. https://doi.org/10.1016/j.juro.2016.04.078
Schneuer FJ, Bentley JP, Davidson AJ et al (2018) The impact of general anesthesia on child development and school performance: a population-based study. Paediatr Anaesth 28:528–536. https://doi.org/10.1111/pan.13390
Glatz P, Sandin RH, Pedersen NL et al (2017) Association of anesthesia and surgery during childhood with long-term academic performance. JAMA Pediatr 171:1–10. https://doi.org/10.1001/jamapediatrics.2016.3470
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Zack Li declares that he has no conflict of interest. Karen Psooy declares that she has no conflict of interest. Melanie Morris declares that she has no conflict of interest. Nafisa Dharamsi declares that she has no conflict of interest. Giuseppe Retrosi declares that he has no conflict of interest.
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Li, Z., Psooy, K., Morris, M. et al. Laparoscopic ligation of ectopic ureter in pediatric patients: a safe surgical option for the management of urinary incontinence due to ectopic ureters. Pediatr Surg Int 37, 667–671 (2021). https://doi.org/10.1007/s00383-020-04852-4
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DOI: https://doi.org/10.1007/s00383-020-04852-4