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SIDE-TO-SIDE URETEROCYSTOTOMY: KEEPING AN "INTACT" UVJ, SIMPLIFYING
THE KAEFER TECHNIQUE AS A STRATEGY TO ADDRESS OBSTRUCTED
MEGAURETERS IN CHILDREN
Fahad ALYAMI
1
, Paul R. BOWLIN
1
, Luis H BRAGA
2
, Martin A. KOYLE
1
and Armando J. LORENZO
1
1) THE HOSPITAL FOR SICK CHILDREN, UNIVERSITY OF TORONTO, UROLOGY, Toronto, CANADA - 2) MCMASTER
CHILDREN HOSPITAL MCMASTER UNIVERSITY, UROLOGY, Hamilton, CANADA
PURPOSE
An obstructed non-refluxing megaureter (OM) is a common diagnosis in neonates with antenatal hydronephrosis(ANH).
Although conservative management is indicated in most cases, surgery is still considered when associated with UTIs,
worsening hydronephrosis or deteriorating renal function. Recently Kaefer described his technique of end-to-side
refluxing ureteric reimplantion for OM, as a temporizing strategy. Herein we describe our experience with a modified
non-dismembered side-to-side refluxing ureterocystotomy(UC) as a simple option for OM.
MATERIAL AND METHODS
Between 2012 and 2014, 25 consecutive side-to-side refluxing UC were performed at two large tertiary centers.
Demographics, surgical indications and follow up results were collected. The procedure was performed through a small
inguinal incision, with a generous refluxing side-to-side anastomosis between the distal ureter and ipsilateral bladder
wall without interference with the urete-rovesical junction or dismemberment.
RESULTS
Mean patient age was 3(0-38) months at time of surgery;9(76%) were males. All patients were initially detected with
ANH and followed with US every3 months and renal scans accordingly. Unilateral procedures were done in 23
patients.The procedure was condcuted for primaryOM in 24 patients and as salvage procedure for obstruction post
common sheath reimplant in 1 child with a duplex system.The average follow up was10 months(1-28).At time of last
follow-up, most children experienced improvement in dilation(80%) or stable findings.
CONCLUSIONS
Our preliminary results show that side-to-side refluxing UC is a simple, feasible, safe minimally invasive procedure for
primary OM,either as a temporizing or definitive intervention. Performing this technique creates a refluxing non-
obstructed system, which can be managed definitively later in the child life if necessary. Considering the pattern of
improvement over time in most OM cases, by virtue of not instrumenting or dismembering the distal ureter, the
anastomosis may be taken down later in life preserving the native ureterovesical junction. Clearly, close follow up is
critical to document the long-term results of the procedure.