Role of Ureterocalicostomy in Children: A Follow Up Study
Purpose Dismembered pyeloplasty remains the main treatment for primary pelviureteric junction obstruction in childhood. However, ureterocalicostomy may be an alternative option in the presence of unfavourable anatomy or recurrent obstruction. Published data regarding ureterocalicostomy in paediatric patients is limited, with no large series reported since 1990. This study was undertaken to document and assess the outcome of ureterocalicostomy as both a primary and salvage procedure in a single centre series of 12 children managed over an 11 year period. Patients and Methods Seven girls and five boys underwent ureterocalicostomy under the care of two surgeons between 1997 and 2008. Median age at operation was 8 years (range 2 - 17). In 7 children primary ureterocalicostomy was performed for horseshoe kidney (3 cases) and gross hydronephrosis with unfavourable anatomy (4 cases). In 5 children salvage ureterocalicostomy was employed for recurrent PUJ obstruction post pyeloplasty. Indications, surgical technique and outcomes were assessed by retrospective analysis of case notes and imaging. Results Similar operative techniques and post operative drainage were employed by both surgeons with a mean operating time of 151 minutes (range 80 – 240). Hospitalisation averaged 5 days (range 3 - 7). No early complications were encountered. Mean follow up was 31 months (SD = 26.7). Successful outcomes were recorded in 10 children (92%) but one child (8%) developed symptomatic recurrent obstruction at 5 months which was successfully corrected by a further procedure. Conclusions We report the first paediatric case series of ureterocalicostomy since 1990. Our findings support the use of this procedure not only as a salvage technique for recurrent pelviureteric junction obstruction but also as an effective primary treatment for selected patients, particularly when associated with horseshoe systems.