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  • Title: Outcome of end cutaneous ureterostomy (ECU) as a non conservative option in the management of primary obstructive megaureters (POM).
    Author: Shrestha AL, Bal HS, Kisku SMC, Sen S.
    Journal: J Pediatr Urol; 2018 Dec; 14(6):541.e1-541.e5. PubMed ID: 29937413.
    Abstract:
    INTRODUCTION: Primary obstructive megaureters (POM) can be treated with one of the following options: conservative management with antibiotic chemoprophylaxis and active observation of the hydroureteronephrosis (HUN) until suspicion of renal deterioration; refluxing/non-refluxing ureteric reimplantation with antibiotic suppression; temporary double-J stenting; endoscopic balloon dilatation; endoureterotomy; and end cutaneous ureterostomy (ECU). OBJECTIVE: To study the profile of patients with POM and assess the efficacy, safety and outcome of ECU as an interim procedure. METHODS: A retrospective review was performed of patients who underwent ECU for POM between January 2004 and December 2014. Demographics, surgical details, and outcomes were studied. RESULTS: A total of 25 patients (19 males, six females) underwent ECU of 25 renal units for POM at a mean age of 7 months (range 23 days to 2.5 years). Of these, nine had presented with radiological worsening of antenatally detected HUN, 12 had symptoms (urosepsis in nine and palpable hydronephrosis in three), three had a solitary kidney in renal failure, and one had incidentally diagnosed renal cortical thinning as shown in Table below. Following diversion, renal failure had resolved in all, and febrile urinary tract infection (UTI) developed in one while awaiting reimplantation. Undiversion was performed in 21/25 patients at a mean duration of 12 months after diversion and a mean age of 19 months. In these, the ureteric size had decreased significantly at reimplantation. In 4/25, undiversion was not performed due to loss of follow-up in two and a subsequent nephrectomy in two. Two out of 21 developed febrile UTI after undiversion. The overall mean follow-up period was 34.2 months (n = 25), while the mean follow-up after undiversion was 41.5 months (n = 21). There was no incidence of stomal complications. CONCLUSIONS: End cutaneous ureterostomy was a safe and effective temporary procedure for the treatment of progressive primary obstructive megaureters.
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