Ipsilateral ureteroureterostomy for the treatment of vesicoureteral refluxor obstruction associated with complete ureteral duplication

Purpose: We reviewed our experience with ureteroureterostomy as definitive treatment for vesicoureteral reflux or obstruction associated with ureteral duplication to determine the efficacy and morbidity of this procedure and identify factors that affect outcome. Materials and Methods: We performed a total of 100 ureteroureterostomies in 94 children with an average age of 28 months during the 23-year period end ing May 1999. Four patients (4 kidneys) failed to return for postoperative evaluation. Followup was 2.5 to 206 months (mean 33). Indications for surge ry were vesicoureteral reflux in 53 cases, obstructing ureterocele in 19, u reterocele with upper pole reflux in 4, an ectopic obstructed upper pole ur eter in 18 and other in 2. In 23 kidneys ureteroureterostomy was combined w ith reimplantation of the recipient ureter. Surgery was considered successf ul when postoperative imaging revealed no reflux or obstruction and a paten t ureteroureterostomy anastomosis. Results: Ureteroureterostomy with or without ureteroneocystostomy was succe ssful for treating 94% of kidneys, including 51 of 53 with reflux, 21 of 23 (91%) with ureterocele and 17 of 18 (94%) with an ectopic obstructed upper pole ureter. Significant ureteral size disparity, defined as a donor urete r diameter greater than 2-fold that of the recipient ureter, was noted in 6 9 kidneys. The most common complication (13 patients) was prolonged output from the Penrose drain. However, this complication did not result in a fail ed procedure in any case. Conclusions: Ipsilateral ureteroureterostomy is safe and efficacious for tr eating abnormalities associated with ureteral duplication. A significant di screpancy in ureteral size does not preclude ureteroureterostomy.