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Ureterocalyceal anastomosis in children: Is it still indicated?
Journal of Pediatric Urology (2009) 5, 78e81
Ureterocalyceal anastomosis in children: Is it still indicated? Osama M. Sarhan*, Tamer E. Helmy, Ashraf T. Hafez, Ahmad M. Ghali, Tarek Mohsen, Mohammed E. Dawaba Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt Received 24 July 2008; accepted 11 August 2008 Available online 14 October 2008
KEYWORDS Ureter; Ureteral obstruction; Pyeloplasty; Surgical procedures; Postoperative complications
Abstract Objective: We report our experience with ureterocalyceal anastomosis in children regarding indications and outcome. Materials and methods: A retrospective review was performed of all cases that underwent open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Clinical and radiological outcome was assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up. Results: There were 10 cases (six males, four females) with a mean age of 6.5 years (range 3e13 years). Follow up ranged from 6 to 46 months (mean 18). The indications for surgery were failed pyeloplasty in six patients and iatrogenic injury of the ureteropelvic junction or the upper ureter in four. No significant perioperative complications were encountered in the study group. Overall success rate was 80%. Relief of obstruction was evident in eight patients as documented by intravenous urography or nuclear renography, while secondary nephrectomy was necessitated in two patients with severely impaired ipsilateral renal function and normal contralateral kidney. In patients with preserved renal units, the differential function on the involved side was stable on comparing the preoperative and postoperative renographic clearance (26 vs 24 ml/min). Conclusion: Ureterocalyceal anastomosis in children is still indicated in some difficult situations. Excellent functional results can be achieved in properly selected cases. Nephrectomy may be indicated in cases with impaired renal function and inability to perform salvage procedure. ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Tel.: þ020 50 2262222; fax: þ020 50 2263717. E-mail address: [email protected] (O.M. Sarhan).
Ureterocalicostomy (UCO) or ureterocalyceal anastomosis is a well-established treatment for patients with complicated ureteropelvic junction (UPJ) obstruction and other
1477-5131/$34 ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2008.08.005
Ureterocalyceal anastomosis in children: Is it still indicated forms of proximal ureteral obstruction. It was first described in 1947 by Neuwirt [1] and several reports have followed [2e9]. The original indication for its use was a failed pyeloplasty but other indications include: ureteropelvic obstruction in conjunction with renal anomalies [4], in renal sparing surgery for renal cell or transitional cell carcinoma [2,4], after traumatic avulsion of the renal pelvis or the upper ureter, after excision of a long segment of ureter and after repeated extensive stone surgeries [6,10]. The success rate of this procedure in children was reported to be as high as in adults [4,7]. Herein we review the indications and outcome of ureterocalyceal anastomosis in 10 children.
Materials and methods A retrospective review was performed to identify patients undergoing open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Clinical and radiological outcome was assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up. In all patients, anatomic factors, including an intrarenal pelvis, peripelvic scarring from a prior intervention, or an inadequate length of ‘viable’ proximal ureter, prompted the performance of this operation. The location and extent of the diseased segment were assessed with preoperative imaging, including retrograde, antegrade and/or intravenous urography, and nuclear renography was used to assess the renal function. The decision to use this technique was based preoperatively on the clinical history and radiological findings (Figs. 1 and 2), but the intraoperative situation confirms the necessity of it. The surgical technique was the same as described in the literature [1e11]. A flank approach was used in all patients and the technique involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calix, thereby providing unobstructed urinary drainage. In each case, the kidney and proximal ureter were dissected to the
79 point of obstruction, and the ureter was ligated with absorbable suture and transected at that level. In all patients, lower pole partial nephrectomy was done rather than a simple incision into a lower calyx. Bleeding from the cut parenchymal margin was controlled in all cases with suture ligatures. Ureteral stents (five internal and five external) and peri-anastomotic drains were placed in all patients. In those patients who presented with indwelling nephrostomy tubes, these were subsequently clamped and removed postoperatively before discharge.
Results A total of 10 children (six boys and four girls), aged 3e13 years (mean 6.5), underwent open UCO at our center. The chief complaint was flank pain, while three patients manifested with recurrent pyelonephritis, three with urinary extravasation after abdominal surgeries, and another four patients had indwelling nephrostomy tubes at their initial evaluation. The reconstruction was performed on the left side in four patients and the right side in six. The indications for surgery in this study group were failed pyeloplasty in six patients, iatrogenic injury of the UPJ in two, and iatrogenic avulsion of the upper ureter in two. All patients underwent surgical reconstruction to achieve resolution of symptoms and preservation of renal function. Follow up ranged from 6 to 46 months (mean 18). Overall success rate was 80%. Of our 10 patients, relief of obstruction was evident in eight as documented by intravenous urography or nuclear renography with decrease or total elimination of obstruction. Secondary nephrectomy was necessitated in two patients with persistent obstruction and severely impaired renal function of the ipsilateral kidney with normal contralateral kidney. In patients with preserved renal units, the differential function on the involved side was stable on comparing the preoperative and postoperative renographic clearance (26 vs 24 ml/min). The details of the original operations, intraoperative findings, interval from the previous operation and outcome of all 10 patients are summarized in Table 1.
Figure 1 Case 7. (A) Preoperative antegrade study revealed hydronephrotic kidney with complete obstruction of the UPJ and no opacification of the ureter. (B) Postoperative antegrade study revealed patent ureterocalyceal anastomosis.
80
O.M. Sarhan et al.
Figure 2 Case 8. (A) Preoperative antegrade study revealed complete obstruction of the UPJ and no opacification of the ureter. (B) Postoperative antegrade study revealed patent ureterocalyceal anastomosis.
Intraoperative findings in these patients that necessitated UCO consisted of extensive peripelvic scarring in all, an intrarenal pelvis in four, too short a ureter to reach the renal pelvis in four, and long upper ureteral narrowing in two. No significant perioperative complications were encountered in the study group and no transfusions were administered. Prolonged urinary leakage was observed in three patients and resolved spontaneously. Two cases developed UTI and were treated with appropriate urinary antiseptics.
Discussion In children, all efforts to salvage an obstructed kidney should be made. A UCO can be used for cases with extensive injuries to the UPJ and proximal ureter [2e12]. When pyeloplasty attempts for UPJ obstruction have failed and result in significant peripelvic fibrosis or a relatively long gap between the renal pelvis and the non-obstructed proximal ureter, the kidney can be salvaged with anastomosis of the proximal ureter directly to the lower calyceal system. This technique also may be used as the primary reconstructive procedure when a UPJ obstruction or proximal ureteral stricture is associated with a relatively small intrarenal pelvis. In this situation, repeat open or percutaneous pyeloplasty has a high restricture rate [12]. UCO also is a useful option when the UPJ is associated with a horseshoe or malrotated kidney in which a standard pyeloplasty does not result in dependent drainage of the collecting system [4]. In our study the most common indication for UCO was failed pyeloplasty, while the other indications were iatrogenic injury of the UPJ and iatrogenic avulsion of the upper ureter. None of our cases was associated with renal anomalies. In these cases, we found that UCO was the only salvage procedure available to preserve the obstructed renal units. Alternatives include autotransplantation, ileal replacement, long-term nephrostomy tube/ureteral stent, renal capsule flap and nephrectomy [2,12e14]. The decision to perform a nephrectomy must be based on the level of
function in the obstructed kidney and the function of the contralateral kidney. If the patient’s renal function is less than 25% for the affected kidney, then surgical correction has a high risk of failure and nephrectomy ultimately may be required. If the patient’s renal function is less than 10%, then recovery is unlikely and initial nephrectomy may be most appropriate. Success rates of 70e90% have been reported following UCO [2,5,7]. Patients in whom this procedure fails often eventually lose the kidney. These results compare with our series, where the success rate was 80% and two cases of failed procedure underwent secondary nephrectomy. In comparison to other studies, our rate of nephrectomy was high and further caution should be taken in the future to spare these kidneys. Postoperative complications may happen and prolonged leakage usually resolves spontaneously. Urinoma formation secondary to extravasation can occur even with adequate placement of drains, stents and nephrostomy tubes. This is managed best by direct percutaneous drainage of fluid collection using guidance with an ultrasound or CT scan. Recurrent stenosis is rare after this procedure. If it occurs, options include autotransplantation, ureteroileal interposition, long-term nephrostomy tube/ureteral stent and nephrectomy [13]. Laparoscopic UCO has recently been reported [15]. Although such studies are scarce, success rates are similar to those of the open procedure. Gill et al. reported on two patients undergoing transperitoneal laparoscopic UCO with documented improvement in renal drainage, although one patient did ultimately undergo nephrectomy because of persistent flank pain. We performed the open technique in all cases, but the laparoscopic approach may be applicable in the near future. We believe that ureterocalyceal anastomosis is an effective alternative to other salvage surgical procedures such as permanent nephrostomy or internal ureteral stents, autotransplantation and ureteral substitution with an ileal segment. All these procedures present some evident drawbacks and limitations.
Ureterocalyceal anastomosis in children: Is it still indicated Table 1
81
Demographic data, presentation and outcome of 10 patients who underwent ureterocalyceal anastomosis.
Case No.
Age (years)
Sex
Presentation
Interval after surgery (months)
Outcome
1 2
13 12
M M
4 7
Good Good
3 4 5 6 7 8
9 5 4 8 3 3
F M F F M M
3 4 3 5 3 6
Nephrectomy Good Nephrectomy Good Good Good
9
5
F
2
Good
10
4
M
Failed pyeloplasty þ Nephrostomy tube fixation Avulsed ureter with urinary leakage þ Nephrostomy tube fixation Failed pyeloplasty þ Nephrostomy tube fixation Avulsed ureter þ Nephrostomy tube fixation Failed pyeloplasty þ Nephrostomy tube fixation Failed pyeloplasty þ Internal stent fixation Failed pyeloplasty þ Nephrostomy tube fixation Avulsed UPJ with urinary ascites þ Nephrostomy tube fixation Avulsed UPJ with urinary extravasation þ Nephrostomy tube fixation Failed pyeloplasty þ internal stent fixation
4
Good
Conclusions Ureterocalyceal anastomosis in children is still indicated in some difficult situations. Excellent functional results can be achieved in properly selected cases. Secondary nephrectomy may be indicated in cases with persistent obstruction and impaired renal function of the ipsilateral kidney and inability to perform salvage procedure.
Conflict of interest The authors have no conflict of interest.
References [1] Neuwirt K. Implantation of the ureter into the lower calyx of the renal pelvis, VII Congres de le Societe Internationale d’Urologie; 1947. p. 253e255. [2] Selli C, Carini M, Turini D, Masini G, Constantini A. Experience with ureterocalyceal anastomosis. Urology 1982;20:7e12. [3] Ross JH, Streem SB, Novick AC, Kay R, Montie J. Ureterocalicostomy for reconstruction of complicated pelviureteric junction obstruction. Br J Urol 1990;65:322e5. [4] Mesrobian HG, Kelalis PP. Ureterocalicostomy: indications and results in 21 patients. J Urol 1989;142:1285e7.
[5] Hawthorne NJ, Zincke H, Kelalis PP. Ureterocalicostomy: an alternative to nephrectomy. J Urol 1976;115:583e6. [6] Slaby DJ, Boeckman C, Nasrallah P. Ureterocalycostomy. Urology 1982;20:377e81. [7] Duckett JW, Pfister RR. Ureterocalicostomy for renal salvage. J Urol 1982;128:98e101. [8] Mollard P, Mouriquand P, Joubert P, Pouyau A. Ureterocalicostomy for hydronephrosis caused by junctions disease in children and adolescents. A propos of 35 cases. Cir Pediatr 1990;31:87e91. [9] Kay R. Ureterocalicostomy. Urol Clin North Am 1988;15:129e33. [10] Smith AD. Management of iatrogenic ureteral strictures after urological procedures. J Urol 1988;140:1372e4. [11] Steffens J, Humke U, Haben B, Stark E, Breitling P, Treiyer A. Open ureterocalycostomy. BJU Int 2008;101: 397e407. [12] Matlagaa BR, Shaha OD, Singhb D, Streemb SB, Assimosa DG. Ureterocalicostomy: a contemporary experience. Urology 2005;65:42e4. [13] Armenakas NA. Current methods of diagnosis and management of ureteral injuries. World J Urol 1999;17: 78e83. [14] Thompson IM, Baker J, Robards Jr VL, Kovacsi L, Ross Jr G. Clinical experience with renal capsule flap pyeloplasty. J Urol 1969;101:487e90. [15] Gill IS, Cherullo EE, Steinberg AP, Desai MM, Abreu SC, Ng C, et al. Laparoscopic ureterocalicostomy: initial experience. J Urol 2004;171:1227e30.
Ureterocalyceal anastomosis in children: Is it still indicated? Osama M. Sarhan*, Tamer E. Helmy, Ashraf T. Hafez, Ahmad M. Ghali, Tarek Mohsen, Mohammed E. Dawaba Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt Received 24 July 2008; accepted 11 August 2008 Available online 14 October 2008
KEYWORDS Ureter; Ureteral obstruction; Pyeloplasty; Surgical procedures; Postoperative complications
Abstract Objective: We report our experience with ureterocalyceal anastomosis in children regarding indications and outcome. Materials and methods: A retrospective review was performed of all cases that underwent open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Clinical and radiological outcome was assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up. Results: There were 10 cases (six males, four females) with a mean age of 6.5 years (range 3e13 years). Follow up ranged from 6 to 46 months (mean 18). The indications for surgery were failed pyeloplasty in six patients and iatrogenic injury of the ureteropelvic junction or the upper ureter in four. No significant perioperative complications were encountered in the study group. Overall success rate was 80%. Relief of obstruction was evident in eight patients as documented by intravenous urography or nuclear renography, while secondary nephrectomy was necessitated in two patients with severely impaired ipsilateral renal function and normal contralateral kidney. In patients with preserved renal units, the differential function on the involved side was stable on comparing the preoperative and postoperative renographic clearance (26 vs 24 ml/min). Conclusion: Ureterocalyceal anastomosis in children is still indicated in some difficult situations. Excellent functional results can be achieved in properly selected cases. Nephrectomy may be indicated in cases with impaired renal function and inability to perform salvage procedure. ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Tel.: þ020 50 2262222; fax: þ020 50 2263717. E-mail address: [email protected] (O.M. Sarhan).
Ureterocalicostomy (UCO) or ureterocalyceal anastomosis is a well-established treatment for patients with complicated ureteropelvic junction (UPJ) obstruction and other
1477-5131/$34 ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2008.08.005
Ureterocalyceal anastomosis in children: Is it still indicated forms of proximal ureteral obstruction. It was first described in 1947 by Neuwirt [1] and several reports have followed [2e9]. The original indication for its use was a failed pyeloplasty but other indications include: ureteropelvic obstruction in conjunction with renal anomalies [4], in renal sparing surgery for renal cell or transitional cell carcinoma [2,4], after traumatic avulsion of the renal pelvis or the upper ureter, after excision of a long segment of ureter and after repeated extensive stone surgeries [6,10]. The success rate of this procedure in children was reported to be as high as in adults [4,7]. Herein we review the indications and outcome of ureterocalyceal anastomosis in 10 children.
Materials and methods A retrospective review was performed to identify patients undergoing open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Clinical and radiological outcome was assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up. In all patients, anatomic factors, including an intrarenal pelvis, peripelvic scarring from a prior intervention, or an inadequate length of ‘viable’ proximal ureter, prompted the performance of this operation. The location and extent of the diseased segment were assessed with preoperative imaging, including retrograde, antegrade and/or intravenous urography, and nuclear renography was used to assess the renal function. The decision to use this technique was based preoperatively on the clinical history and radiological findings (Figs. 1 and 2), but the intraoperative situation confirms the necessity of it. The surgical technique was the same as described in the literature [1e11]. A flank approach was used in all patients and the technique involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calix, thereby providing unobstructed urinary drainage. In each case, the kidney and proximal ureter were dissected to the
79 point of obstruction, and the ureter was ligated with absorbable suture and transected at that level. In all patients, lower pole partial nephrectomy was done rather than a simple incision into a lower calyx. Bleeding from the cut parenchymal margin was controlled in all cases with suture ligatures. Ureteral stents (five internal and five external) and peri-anastomotic drains were placed in all patients. In those patients who presented with indwelling nephrostomy tubes, these were subsequently clamped and removed postoperatively before discharge.
Results A total of 10 children (six boys and four girls), aged 3e13 years (mean 6.5), underwent open UCO at our center. The chief complaint was flank pain, while three patients manifested with recurrent pyelonephritis, three with urinary extravasation after abdominal surgeries, and another four patients had indwelling nephrostomy tubes at their initial evaluation. The reconstruction was performed on the left side in four patients and the right side in six. The indications for surgery in this study group were failed pyeloplasty in six patients, iatrogenic injury of the UPJ in two, and iatrogenic avulsion of the upper ureter in two. All patients underwent surgical reconstruction to achieve resolution of symptoms and preservation of renal function. Follow up ranged from 6 to 46 months (mean 18). Overall success rate was 80%. Of our 10 patients, relief of obstruction was evident in eight as documented by intravenous urography or nuclear renography with decrease or total elimination of obstruction. Secondary nephrectomy was necessitated in two patients with persistent obstruction and severely impaired renal function of the ipsilateral kidney with normal contralateral kidney. In patients with preserved renal units, the differential function on the involved side was stable on comparing the preoperative and postoperative renographic clearance (26 vs 24 ml/min). The details of the original operations, intraoperative findings, interval from the previous operation and outcome of all 10 patients are summarized in Table 1.
Figure 1 Case 7. (A) Preoperative antegrade study revealed hydronephrotic kidney with complete obstruction of the UPJ and no opacification of the ureter. (B) Postoperative antegrade study revealed patent ureterocalyceal anastomosis.
80
O.M. Sarhan et al.
Figure 2 Case 8. (A) Preoperative antegrade study revealed complete obstruction of the UPJ and no opacification of the ureter. (B) Postoperative antegrade study revealed patent ureterocalyceal anastomosis.
Intraoperative findings in these patients that necessitated UCO consisted of extensive peripelvic scarring in all, an intrarenal pelvis in four, too short a ureter to reach the renal pelvis in four, and long upper ureteral narrowing in two. No significant perioperative complications were encountered in the study group and no transfusions were administered. Prolonged urinary leakage was observed in three patients and resolved spontaneously. Two cases developed UTI and were treated with appropriate urinary antiseptics.
Discussion In children, all efforts to salvage an obstructed kidney should be made. A UCO can be used for cases with extensive injuries to the UPJ and proximal ureter [2e12]. When pyeloplasty attempts for UPJ obstruction have failed and result in significant peripelvic fibrosis or a relatively long gap between the renal pelvis and the non-obstructed proximal ureter, the kidney can be salvaged with anastomosis of the proximal ureter directly to the lower calyceal system. This technique also may be used as the primary reconstructive procedure when a UPJ obstruction or proximal ureteral stricture is associated with a relatively small intrarenal pelvis. In this situation, repeat open or percutaneous pyeloplasty has a high restricture rate [12]. UCO also is a useful option when the UPJ is associated with a horseshoe or malrotated kidney in which a standard pyeloplasty does not result in dependent drainage of the collecting system [4]. In our study the most common indication for UCO was failed pyeloplasty, while the other indications were iatrogenic injury of the UPJ and iatrogenic avulsion of the upper ureter. None of our cases was associated with renal anomalies. In these cases, we found that UCO was the only salvage procedure available to preserve the obstructed renal units. Alternatives include autotransplantation, ileal replacement, long-term nephrostomy tube/ureteral stent, renal capsule flap and nephrectomy [2,12e14]. The decision to perform a nephrectomy must be based on the level of
function in the obstructed kidney and the function of the contralateral kidney. If the patient’s renal function is less than 25% for the affected kidney, then surgical correction has a high risk of failure and nephrectomy ultimately may be required. If the patient’s renal function is less than 10%, then recovery is unlikely and initial nephrectomy may be most appropriate. Success rates of 70e90% have been reported following UCO [2,5,7]. Patients in whom this procedure fails often eventually lose the kidney. These results compare with our series, where the success rate was 80% and two cases of failed procedure underwent secondary nephrectomy. In comparison to other studies, our rate of nephrectomy was high and further caution should be taken in the future to spare these kidneys. Postoperative complications may happen and prolonged leakage usually resolves spontaneously. Urinoma formation secondary to extravasation can occur even with adequate placement of drains, stents and nephrostomy tubes. This is managed best by direct percutaneous drainage of fluid collection using guidance with an ultrasound or CT scan. Recurrent stenosis is rare after this procedure. If it occurs, options include autotransplantation, ureteroileal interposition, long-term nephrostomy tube/ureteral stent and nephrectomy [13]. Laparoscopic UCO has recently been reported [15]. Although such studies are scarce, success rates are similar to those of the open procedure. Gill et al. reported on two patients undergoing transperitoneal laparoscopic UCO with documented improvement in renal drainage, although one patient did ultimately undergo nephrectomy because of persistent flank pain. We performed the open technique in all cases, but the laparoscopic approach may be applicable in the near future. We believe that ureterocalyceal anastomosis is an effective alternative to other salvage surgical procedures such as permanent nephrostomy or internal ureteral stents, autotransplantation and ureteral substitution with an ileal segment. All these procedures present some evident drawbacks and limitations.
Ureterocalyceal anastomosis in children: Is it still indicated Table 1
81
Demographic data, presentation and outcome of 10 patients who underwent ureterocalyceal anastomosis.
Case No.
Age (years)
Sex
Presentation
Interval after surgery (months)
Outcome
1 2
13 12
M M
4 7
Good Good
3 4 5 6 7 8
9 5 4 8 3 3
F M F F M M
3 4 3 5 3 6
Nephrectomy Good Nephrectomy Good Good Good
9
5
F
2
Good
10
4
M
Failed pyeloplasty þ Nephrostomy tube fixation Avulsed ureter with urinary leakage þ Nephrostomy tube fixation Failed pyeloplasty þ Nephrostomy tube fixation Avulsed ureter þ Nephrostomy tube fixation Failed pyeloplasty þ Nephrostomy tube fixation Failed pyeloplasty þ Internal stent fixation Failed pyeloplasty þ Nephrostomy tube fixation Avulsed UPJ with urinary ascites þ Nephrostomy tube fixation Avulsed UPJ with urinary extravasation þ Nephrostomy tube fixation Failed pyeloplasty þ internal stent fixation
4
Good
Conclusions Ureterocalyceal anastomosis in children is still indicated in some difficult situations. Excellent functional results can be achieved in properly selected cases. Secondary nephrectomy may be indicated in cases with persistent obstruction and impaired renal function of the ipsilateral kidney and inability to perform salvage procedure.
Conflict of interest The authors have no conflict of interest.
References [1] Neuwirt K. Implantation of the ureter into the lower calyx of the renal pelvis, VII Congres de le Societe Internationale d’Urologie; 1947. p. 253e255. [2] Selli C, Carini M, Turini D, Masini G, Constantini A. Experience with ureterocalyceal anastomosis. Urology 1982;20:7e12. [3] Ross JH, Streem SB, Novick AC, Kay R, Montie J. Ureterocalicostomy for reconstruction of complicated pelviureteric junction obstruction. Br J Urol 1990;65:322e5. [4] Mesrobian HG, Kelalis PP. Ureterocalicostomy: indications and results in 21 patients. J Urol 1989;142:1285e7.
[5] Hawthorne NJ, Zincke H, Kelalis PP. Ureterocalicostomy: an alternative to nephrectomy. J Urol 1976;115:583e6. [6] Slaby DJ, Boeckman C, Nasrallah P. Ureterocalycostomy. Urology 1982;20:377e81. [7] Duckett JW, Pfister RR. Ureterocalicostomy for renal salvage. J Urol 1982;128:98e101. [8] Mollard P, Mouriquand P, Joubert P, Pouyau A. Ureterocalicostomy for hydronephrosis caused by junctions disease in children and adolescents. A propos of 35 cases. Cir Pediatr 1990;31:87e91. [9] Kay R. Ureterocalicostomy. Urol Clin North Am 1988;15:129e33. [10] Smith AD. Management of iatrogenic ureteral strictures after urological procedures. J Urol 1988;140:1372e4. [11] Steffens J, Humke U, Haben B, Stark E, Breitling P, Treiyer A. Open ureterocalycostomy. BJU Int 2008;101: 397e407. [12] Matlagaa BR, Shaha OD, Singhb D, Streemb SB, Assimosa DG. Ureterocalicostomy: a contemporary experience. Urology 2005;65:42e4. [13] Armenakas NA. Current methods of diagnosis and management of ureteral injuries. World J Urol 1999;17: 78e83. [14] Thompson IM, Baker J, Robards Jr VL, Kovacsi L, Ross Jr G. Clinical experience with renal capsule flap pyeloplasty. J Urol 1969;101:487e90. [15] Gill IS, Cherullo EE, Steinberg AP, Desai MM, Abreu SC, Ng C, et al. Laparoscopic ureterocalicostomy: initial experience. J Urol 2004;171:1227e30.