Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age

Abstract

Purpose: This study aimed to assess the outcome of intravesical ureteric reimplantation for primary obstructed megaureter (POM) performed in infants under 1 year of age.

Materials and methods: A retrospective cohort study was carried out of all infants undergoing intravesical ureteric reimplantation surgery for POM at two pediatric centers in the 12 years between 2003 and 2014. Outcomes were compared with those of children aged over 1 year undergoing intravesical reimplantation for POM during this period. Follow-up was until November 2015.

Results: Thirty-seven megaureters in 34 infants were reimplanted, at median age 5.2 months (Table). Operative success was 97%, with one out of 34 patients (3%) requiring reoperation for recurrent ureteric obstruction. Renal preservation was high. One patient of 34 (3%), who had bilateral congenital renal dysplasia, showed evidence of decline in renal function. Five patients of 34 (15%) had postoperative urinary tract infections (UTIs). Four (13%) of those toilet trained had some symptoms of lower urinary tract dysfunction (LUTD). Three patients (9%) who had congenitally dysplastic kidneys developed hypertension. Comparatively, 14 children with POM underwent reimplantation over 1 year of age. Operative success was 86%, with two children requiring reoperation for recurrent stenosis. Both had evidence of bladder dysfunction before surgery, and thickened bladder walls noted during surgery. One of 14 (7%) had a decline in ipsilateral renal function after recurrent stenosis. Two (14%) had postoperative UTI. Three (25%) had evidence of LUTD.

Discussion: There are few data about feasibility and long-term outcomes specifically of ureteric reimplantation for POM in infancy. This is the first study to document long-term outcomes of intravesical ureteric reimplantation in infancy for POM. The recently published British Association of Paediatric Urologists consensus statement supports delaying definitive reimplantation surgery for POM that requires intervention until after 1 year of age. There is little evidence presented for this recommendation. Our study confirms the safety and feasibility of intravesical ureteric reimplantation for POM in infants under age 1, with an operative success rate of 97%, and high renal function preservation rate. UTI risk improved after surgery in children >6 months old and remained stably low in those <6 months of age. Postoperative rates of LUTD were low. Hypertension occurred in only three cases with congenital renal dysplasia.

Conclusions: Ureteric reimplantation in infants under 1 year of age is a safe and effective option for managing POM that requires intervention, and compares favorably with those undergoing reimplantation over 1 year of age.

Keywords: Child; Infant; Ureteral obstruction; Urologic surgical procedures.