Primary ureterocalicostomy in children

Introduction: Ureterocalicostomy involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calyx. Ureterocalicostomy offers distinct advantages over conventional Anderson–Hynes pyeloplasty for the primary surgical management of pelvi-ureteric junction obstruction, notably for obstruction secondary to complicating anatomical anomalies of the kidney, such as horseshoe kidney. The present study was aimed to evaluate the outcome of primary laparoscopic ureterocalicostomy as a primary procedure in children. Materials and Methods: The technique of ureterocalicostomy employed was similar in all children and comprised disconnection of the ureter from the renal pelvis and identification of the most dependent portion of the lower pole calyx by instrumentation within the collecting system. Results: Eight children (five males and three females) underwent primary ureterocalicostomy during the study period. The mean age of the children was 11.37 ± 3.67 years. Five of the eight children underwent laparoscopic ureterocalicostomy, whereas in three, it was necessary to convert to open as the dissection was difficult. The mean operating time was 134 ± 12 min, and the mean blood loss was 48 ± 7.48 cc. Conclusions: Our study shows that primary laparoscopic ureterocalicostomy for ureteropelvic junction obstruction is feasible, safe, and associated with minimal morbidity.