Repeated ureterocystoneoimplantation in a 13-year child with recurrent vesicoureteral reflux in both segments of a doubled kidney

Introduction. Doubling of the urinary tract is a common developmental anomaly (0.8–1.0%). With complete doubling, vesicoureteral reflux (VUR) is detected in 66-72%, mainly in the lower segment. The aim of the work is to optimize the surgical treatment of VUR with doubling of the urinary tract by endoluminal plasty of the ureteral mouths and reimplantation of the ureter.

Materials and methods. In a 13-year child, a laparoscopic longitudinal intravesical ureterocystoneoimplantation technique was used in conditions of ureteral length deficiency and a proximal intervertebral anastomosis was applied.

Results. With the doubling of the urinary tract, a number of patients experience a recurrence of VUR, which determines the need for repeated reconstructive surgery. We present a clinical case of successful surgical treatment of recurrent VUR in both segments of a doubled kidney in a 13-year child. In the treatment, the technique of laparoscopic longitudinal intravesical ureterocystoneoimplantation was successfully applied in conditions of ureteral length deficiency and a proximal intervertebral anastomosis was applied.

Conclusion. The performed surgical intervention meets the requirements of efficiency and safety and can be used in conditions of ureteral length deficiency in patients with recurrent VUR after previously performed reconstructive operations.

Contribution:
Sharkov S.M., Shmyrov O.S. — concept and design of the study;
Margieva D.A. — collection and processing of the material;
Margieva D.A., Sharkov S.M. — writing the text; Margieva D.A., Sharkov S.M., Shmyrov O.S., Kulaev A.V., Surov R.V., Lazishvili M.N., Kozyrev G.V., Morozov K.D., Kovachich A.S., Lobach A.Yu. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 20, 2024
Accepted: October 08, 2024
Published: November 12, 2024

1. Chertin L., Neeman B.B., Stav K., Noh PH., Koucherov S., Gaber J., et al. Robotic versus laparoscopic ipsilateral uretero-ureterostomy for upper urinary tract duplications in the pediatric population: a multi-institutional review of outcomes and complications. J. Pediatr. Surg. 2021; 56(12): 2377–80. https://doi.org/10.1016/j.jpedsurg.2020.12.022

2. Michaud J.E., Akhavan A. Upper pole heminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters. Curr. Urol. Rep. 2017; 18(3): 21. https://doi.org/10.1007/s11934-017-0664-0

3. Ransley P.G., Risdon R.A. Reflux nephropathy: effects of antimicrobial therapy on the evolution of the early pyelonephritic scar. Kidney Int. 1981; 20(6): 733–42. https://doi.org/10.1038/ki.1981.204

4. Williams G., Craig J.C. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst. Rev. 2019; 4(4): CD001534. https://doi.org/10.1002/14651858.CD001534.pub4

5. Abdullaev F.K., Kulaev V.D., Nikolaev V.V., Guseinov A.Ya. Endoscopic treatment of vesicoureteral reflux in children who underwent transurethral electroincision of ureterocele. Detskaya bolnitsa. 2013; (2): 23–8. https://elibrary.ru/sdylrb (in Russian)

6. Heidenreich A., Becker T., Hofmann R. Ureteral reimplantation: a comparison of results with the Lich-Gregoir, psoas hitch and Politalo-Leadbetter techniques in 196 children. Urol. A (Suppl). 2006; S40: 1.14. https://doi.org/10.1007/s00345-004-0408-x

7. Demchenko V.N., Garagaty A.I., Shchukin D.V., Maltsev A.V., Strakhovetsky V.S. Functional changes bladder after the Boari operation. The Scientific Heritage. 2020; 46(3): 11–6. https://elibrary.ru/hvybtb (in Russian)