Influence of significant difference in diameters of ureters on the possibility and effectiveness of ureteroureterostomy in the treatment of obstructive uropathies of the duplicated kidney

Abstract

BACKGROUND: Laparoscopic ureteroureterostomy is increasingly used as a surgical correction method for obstructive uropathies of the duplicated kidney. A complicating factor for this technique may be a significant difference between the diameters of the ureters. AIM: This study aimed to analyze the effectiveness and safety of laparoscopic ureteroureterostomy in patients with obstructive uropathies of the duplicated kidney with a twofold or more difference in ureter diameters. MATERIALS AND METHODS: Among 14 children who underwent laparoscopic ureteroureterostomy for obstructive uropathies of the duplicated kidney at Almazov National Medical Research Centre between 2021 and 2023, in 10 patients (71.4%), the diameter of the “donor” ureter exceeded the diameter of the “recipient” ureter two times or more. RESULTS: In most patients, the indication for surgery was obstructive megaureter of the segment. All patients underwent laparoscopic ureteroureterostomy, proximal in 90% of cases and distal in one child. One of five patients underwent transurethral resection of the ureterocele as the first stage of operative treatment. The only complication observed in the postoperative period in the presented patients was a stent-associated urinary tract infection, which was treated conservatively. One child (10%) required ureter reimplantation with stump resection after ureteroureterostomy. CONCLUSIONS: Laparoscopic ureteroureterostomy is a safe and effective method for surgical correction of obstructive uropathies of the duplicated kidney although a significant difference is noted between the diameters of the “donor” and “recipient” ureters. This factor does not reduce the effectiveness of ureteroureterostomy and does not lead to an increased risk of postoperative complications and reoperations. Thus, laparoscopic ureteroureterostomy can be used in patients with obstructive uropathies of the duplicated kidney.