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Features of surgical treatment of ureteropelvic junction obstruction of the lower pole in incomplete duplication of the upper urinary tract DOI: 10.29188/2222-8543-2020-13-4-140-145
Sizonov V.V., Bondarenko S.G., Kagantsov I.M., Dubrov V.I., Kuzovleva G.I., Shidaev A.Kh-A. Features of surgical treatment of
obstruction of the pyeloureteral segment of the lower half of the doubled kidney against the background of incomplete doubling of the upper urinary tract. Experimental and Clinical Urology 2020(4):140-145. https://doi.org/10.29188/2222-8543-2020-13-4-140-145
Sizonov V.V. – Dr. Sc, associate professor, professor at the Department of urology and reproductive health with the course of pediatric urology and andrology of FGBOU VO «Rostov State Medical University of the Minzdrav of Russia, Head of the Pediatric Uroandrologic Department of Rostov Regional Children’s Hospital; Rostov-on-Don, Russia; https://orcid.org/0000-0001-9145-8671
Bondarenko S.G. – PhD. Head of the Department of Urology, Clinical Emergency Hospital № 7, Volgograd, Russia; https://orcid.org/0000-0001-5130-4782
Kagantsov I.M. – Dr.Sc., Professor at the Department of Surgical Diseases, Pitirim Sorokin Syktyvkar State University, Head of Department of Urology, Republican Children’s Clinical Hospital; Syktyvkar, Russia; https://orcid.org/0000-0002-3957-1615
Dubrov V.I. – PhD. Head of the Department of Urology, the 2nd Children’s Hospital; Minsk, Republic of Belarus; https://orcid.org/0000-0002-3705-1288
Shidaev A.Kh. - Postgraduate student of the Department of Urology with the course of Pediatric Urology-Andrology, Rostov State Medical University; Rostov-on-Don, Russia; https://orcid.org/0000-0002-8634-6453
Introduction. The combination duplication of upper urinary tract with ureteropelvic junction obstruction (UPJO) is a rather rare anomaly with a frequency of 2-7% among all UPJO. The rather low frequency of occurrence of UPJO in the duplex kidney and the variability of its anatomical variants determine the absence of standardized approaches to the choice of the method of plastic intervention.
Materials and methods. The article presents the results of surgical treatment of 26 children with UPJO in the lower pole of a duplex kidney over the past 20 years in 7 clinics of the Russian Federation and the Republic of Belarus. Children are divided into 3 groups depending on the type of surgical technique. Group 1 – dismembered pyeloplasty of the lower pole with the formation of an end-to-end anastomosis between the pelvis and the ureter of the lower pole. Group 2 – ureteropyeloanastomosis side-to-side between the ureter of the upper pole and the pelvis of the lower pole. Group 3 – dismembered pyeloplasty of the lower pole end-to-end with a common ureter with simultaneous formation of a submerged ureteropyeloanastomosis end-to-side between the ureter of the upper pole and the pelvis of the lower pole.
Results. Postoperative complications of varying severity according to Clavien-Dindo were observed in 4 (15.4%) children. 3 (11.5%) patients required repeated pyeloplasty. The immersive anastomosis in group 3 patients functioned satisfactorily in all cases.
Conclusion. The experience of surgical treatment of UPJO in the lower pole of the duplex kidney demonstrates a higher recurrence rate compared to standard pyeloplasty. The variability of the anatomical features of the UPJO of the lower pole of the duplex kidney determines the need for a personalized approach to the choice of the UPJO reconstruction technique.