1 - Serviço de Cirurgia Pediátrica; Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, E.P.E.
- Poster – 14.º Congresso SPCMIN, Peniche, 29 e 30 Outubro de 2021
Resumo:
Introduction: Uretero-ureterostomy is a century old procedure for the approach of a duplex renal system. It since has evolved into a minimally invasive procedure, and effective results of laparoscopic and robotic uretero-ureterostomies in pediatric patients have been reported. The video-assisted uretero-ureterostomy is a procedure that combines the delicate laparoscopic dissection of the common ureteric sheet, and the less technically demanding open end-to-side anastomosis. For the last 4 year we have been using this hybrid procedure to treat patients with urinary tract duplications and upper pole obstruction by ureteroceles or ectopic ureter.
Methods and results: We retrospectively reviewed the clinical records of the first 9 patients that underwent video-assisted uretero-ureterostomy since 2018. Demographic data was collected, as well as data regarding pre-operative exams and indications for surgery. Mean operative time, length of stay, days with urinary catheter and postoperative outcomes were registered. Eight patients were girls. Age ranged between 15 and 123 months of age, with 55% right side duplicated systems. The indications for surgery were obstructive megaureter, with or without ureterocele (5), incontinence (2), recurrent urinary tract infections (UTIs) and loss of function of the upper pole. In all cases lower pole vesicoureteral reflux was excluded before surgery. The mean operative time was 2,5 hours. Mean length of hospital stay was of 3,3 days (range 2 - 6), patients had a vesical catheter for 3 days, and required only non-opioid analgesics. No post-operative complications, like UTIs, anastomotic leak or stenosis were registered. A trans-anastomotic stent was left in place for a mean of 95,5 days. Mean follow up time was 3,4 months (ranging from 1 to 12 months). All patients had a postoperative renal and bladder ultrasound, with no alterations registered.
Discussion: Video-assisted uretero-ureterostomy is a safe and cunning procedure in children with obstructed duplex collecting systems, that obviates the technically demanding skills of laparoscopic suturing, has a short hospital stay, low postoperative pain and good cosmetic results. It can also be an alternative to heminephrectomy even in poorly or non-function moieties, with low complication rate.
Palavras-Chave: Video-assisted uretero-ureterostomy, duplex renal system