Comparing the outcomes of three UU surgical methods for the treatment of complete duplex kidney: Changes to continually improve surgical success and reduce operative time and operative difficulty

Abstract

Introduction: Duplex kidney is a common malformation of the urinary system among children. There are various treatment options for this malformation.

Objective: This study aimed to compare the therapeutic effects of three minimally invasive urinary tract reconstruction surgery methods for complete duplex kidney among children and to compare demographic characteristics, perioperative data, surgical techniques, complications, and outcomes between these three methods.

Patients and methods: This retrospective study included 93 children with complete duplex kidney. A total of 35 patients underwent laparoscopic proximal ureteroureterostomy (Group A), 35 patients underwent laparoscopic distal ureteroureterostomy (Group B), and 23 patients underwent laparoscopic mobilization with open inguinal incision ureteroureterostomy (Group C). Clinical data and surgery-related outcomes were recorded and collected. Routine follow-up was performed in all three groups. The rates of preoperative and postoperative renal pelvis separation, ureteral dilation, and operation time were compared among the three groups.

Results: The operation times in Group A, Group B, and Group C were 121.46 ± 35.15 min, 110.09 ± 25.60 min, and 87.95 ± 21.03 min, respectively (P < 0.001), which were significantly different. The laparoscopic combined open surgery group had the shortest time. The overall incidence of complications in the three groups of surgeries was 31.4 %, 17.1 %, and 4.35 %, respectively. There was a statistically significant difference in the incidence of complications between Group A and Group C (31.4 % vs. 4.35 %; P = 0.013). In Group A, more severe postoperative complications related to the anastomotic site were reported; 14.3 % of patients in this group required secondary surgery.

Discussion: Herein, we comprehensively compared the clinical efficacy and safety of three surgical procedures and found that laparoscopic ipsilateral ureteroureterostomy (LIUU) is a safe and effective treatment for complete duplex kidney. Based on these findings, we reformed a small inguinal incision during LIUU and combined it with extracorporeal methods to efficiently reconstruct the ureter, thereby significantly decreasing surgical time, reducing surgical difficulty, and further improving the treatment effect on complete duplex kidney.

Conclusions: LIUU is a safe and effective treatment for complete renal duplication, whereas proximal UU is associated with more serious complications related to the anastomotic site. Laparoscopic mobilization with open inguinal incision anastomosis showed high efficacy and safety, a shortened operation time and a lower incidence of severe complications.

Keywords: Children; Duplex kidney; Inguinal incision; Ureteroureterostomy.