The treatment policy in children with combined stenosis of ureteropelvic junction and extended ureter hypoplasia

Treatment of ureteropelvic junction (UPJ) combined anomalies and segmental hypoplasia of extended portion of ureter is a major problem in pediatric urology. There is a large quantity of complications after surgical correction of anomalies and high rate of nephrectomies mentioned in publications. Since 1994 to 1998 we observed 146 children with UPJ obstruction, 130 of them underwent surgery due to Anderson-Hynes technique. 57 (38%) patients, along with the combined UPJ stricture and ureteral hypoplasia had other abnormalities of the urinary tract, with 7 children (4.3%) in the age from 3 weeks to 13 years, which had segmental hypoplasia of ureter on a large extension with normal or partially preserved function of the kidneys. In all patients percutaneous nephrostomy with urine flow restoration from kidneys was performed prior to surgery. All children underwent pyeloplasty with a long-term insertion of JJ-stents for 6 to 24 months. Two patients underwent pyeloplasty using a free fascial flap. In one kid primary ureteral plastic with an ileum segment was performed. In 5 cases we observed gradual recovery of UPJ function after surgery. All treated children had recovery of renal excretory function. In one child after 2 years of stenting and partial improvement of renal function, the ureter was completely replaced by a segment of ileum. Our results of treatment of this complex combined anomaly proved the positive effect of antireflux ureteral stenting for the long term. According to our view, the replacement of the ureter with a segment of ileum should only be conducted due to the dynamics of the disease.