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| Name | Class |
|---|---|
| Vinmec Research Institute of Stem Cell and Gene Technology | OTHER |
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Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children.
Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children.
Demographic data of patients, their clinical manifestations, classification of hydronephrosis based on the guidelines established by the Society for Fetal Urology (SFU), dimensions of the renal pelvis measured in the anterior-posterior direction (APD), diameters of the ureters, duration of surgical procedures, duration of hospitalization, and subsequent follow-up information were systematically gathered prospectively to evaluate the long-term outcomes of the proposing surgical technique.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Complete duplicated collecting system | The presence of two pelvicalyceal systems within a single kidney, with either obstructed or ectopic ureter |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| one trocar-assisted retroperitoneoscopic ureteroureterostomy (OTAU) | Procedure | A 12 mm transverse incision was made just above the iliac crest, followed by careful dissection of the fascia and muscle layer to expose the Gerota's fascia. Entry into the retroperitoneal space was achieved with a 10-mm balloon trocar, allowing for pneumoretroperitoneum establishment. Using a 10-mm laparoscope equipped with a Maryland dissector, the ureters were dissected and isolated, followed by careful exteriorization of both upper and lower pole moiety ureters with a Babcock grasper. The pathological upper pole moiety ureter was transected, preserving the normal lower pole moiety ureter and shared blood supply, and closed with a Vicryl 4/0 suture. Subsequently, an end-to-side ureteroureterostomy was performed with a 6/0 Polydioxanone running suture, with antegrade insertion of a double J stent if not previously conducted. A final retroperitoneoscopic evaluation ensured proper anastomosis alignment, and the incision was closed without drainage. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean operating time | The average operating time (minutes) of OTAU | through study completion (4 years) |
| Intraoperative complications | Complications experienced during the procedure | through study completion (4 years) |
| Conversion to open | Incidence in which the operation must be switch to open surgery | through study completion (4 years) |
| Early postoperative complications | Complications after OTAU including UTI and wound infection | through study completion (4 years) |
| Median length of hospital stays | Average time (days) the patient has to stay at the hospital post-operation | through study completion (4 years) |
| Mean UPM renal pelvis' APD | The average anterior-posterior diameter (mm) of the upper pole moiety before and after the operation | through study completion (4 years) |
| Mean SFU of UPM renal pelvis | The average Society of Fetal Urology classification of the upper pole moiety before and after the operation | through study completion (4 years) |
| Mean UPM ureter's diameter |
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Inclusion Criteria:
Exclusion Criteria:
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Pediatric patients diagnosed with ureteral duplication, including with either ectopic or obstructed ureter, were treated with OTAU between September 2016 and December 2020. Preoperative diagnostic evaluations included blood tests, urinalysis, culture, renal ultrasonography (US), and voiding cystourethrogram to identify vesicoureteral reflux. Dimercaptosuccinic acid (DMSA) scintigraphy was used to measure the differential renal function (DRF). UU was performed irrespective of the differential function of the upper pole moiety (UPM) or the patient's age.
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| Name | Affiliation | Role |
|---|---|---|
| Quang T Nguyen, M.D. | : Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The National Hospital of Pediatrics | Hanoi | Vietnam | ||||
| Vinmec Research Institute of Stem Cell and Gene Technology |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 6502807 | Background | Glassberg KI, Braren V, Duckett JW, Jacobs EC, King LR, Lebowitz RL, Perlmutter AD, Stephens FD. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol. 1984 Dec;132(6):1153-4. doi: 10.1016/s0022-5347(17)50072-5. | |
| 17707022 | Background | Chacko JK, Koyle MA, Mingin GC, Furness PD 3rd. Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication. J Urol. 2007 Oct;178(4 Pt 2):1689-92. doi: 10.1016/j.juro.2007.05.098. Epub 2007 Aug 17. |
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|
The average ureter's diameter (mm) of the upper pole moiety before and after the operation
| through study completion (4 years) |
| Mean UPM DRF | The average differential renal function (%) (measurement of each kidney's ability to extract tracer from blood) of the upper pole moiety before and after operation | through study completion (4 years) |
| Mean DRF of operated side | The average differential renal function (%) of the operated side before and after operation | through study completion (4 years) |
| Hanoi |
| Vietnam |
| 9017803 | Background | Fernbach SK, Feinstein KA, Spencer K, Lindstrom CA. Ureteral duplication and its complications. Radiographics. 1997 Jan-Feb;17(1):109-27. doi: 10.1148/radiographics.17.1.9017803. |
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| 11176433 | Background | Lashley DB, McAleer IM, Kaplan GW. Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication. J Urol. 2001 Feb;165(2):552-4. doi: 10.1097/00005392-200102000-00067. |
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| 26443241 | Background | Herz D, Smith J, McLeod D, Schober M, Preece J, Merguerian P. Robot-assisted laparoscopic management of duplex renal anomaly: Comparison of surgical outcomes to traditional pure laparoscopic and open surgery. J Pediatr Urol. 2016 Feb;12(1):44.e1-7. doi: 10.1016/j.jpurol.2015.04.046. Epub 2015 Aug 17. |
| 30477994 | Background | Wong NC, Braga LH. Open ureteroureterostomy for repair of upper-pole ectopic ureters in children with duplex systems: is stenting really necessary? J Pediatr Urol. 2019 Feb;15(1):72.e1-72.e7. doi: 10.1016/j.jpurol.2018.10.014. Epub 2018 Oct 24. |
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| 17868427 | Result | Lowe GJ, Canon SJ, Jayanthi VR. Laparoscopic reconstructive options for obstruction in children with duplex renal anomalies. BJU Int. 2008 Jan;101(2):227-30. doi: 10.1111/j.1464-410X.2007.07106.x. Epub 2007 Sep 13. |
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| 26159231 | Result | Lee NG, Corbett ST, Cobb K, Bailey GC, Burns AS, Peters CA. Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population. J Endourol. 2015 Nov;29(11):1237-41. doi: 10.1089/end.2015.0223. Epub 2015 Aug 21. |
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