TOPLINE

Distal ureteroureterostomy was effective in children with duplex kidney anomalies, with no patients requiring reoperation after a median follow-up of 45 months. Upper moiety hydronephrosis improved significantly in around 88% of patients, whereas only two children developed lower moiety hydronephrosis.

METHODOLOGY

• Researchers conducted a retrospective review of 53 children (45 girls and eight boys) who underwent distal ureteroureterostomy for duplex kidney anomalies between 2008 and 2025 (median age at surgery, 15 months).
• Main surgical indications were recurrent febrile urinary tract infections (UTIs) despite continuous antibiotic prophylaxis, progressive upper tract dilatation, and urinary incontinence, occurring in 47.2%, 34.0%, and 18.9% of patients, respectively; all patients with urinary incontinence were girls.
• Follow-up data were available for 45 children, with a median follow-up duration of 45 months; ultrasound examinations of the kidneys and lower urinary tract were performed.

TAKEAWAY

• The median operative time was 118 minutes, with no intraoperative complications; early postoperative febrile UTIs occurred in only 3 of 53 patients (5.7%). None of the patients developed clinically relevant obstruction of the lower moiety or needed another surgery.
• Among 43 patients with preoperative upper moiety hydronephrosis, significant improvement was observed in 88.4% of patients, with a median reduction in pelvic diameter of 11 mm (P < .001); upper moiety ureteral dilatation resolved or improved in nearly all patients.
• Only 2 of 45 patients (4.4%) developed lower moiety hydronephrosis during follow-up; both had unobstructed drainage on postoperative renal scintigraphy.
• The initial donor ureter diameter was not significantly associated with the persistence of upper portion dilatation or increased upper portion hydronephrosis. The initial distal upper moiety ureteral diameter was not significantly associated with newly developed lower portion hydronephrosis.

IN PRACTICE

"Distal UU [ureteroureterostomy] represents a safe, effective, and definitive reconstructive option for children with duplex kidney anomalies and ectopic or obstructed upper moiety ureters," the authors wrote.

SOURCE

The study was led by Marios Marcou of the Department of Pediatric Urology in the Mother-Child Clinic St. Hedwig at Hospital St. John of God in Regensburg, Germany. It was published online on August 20, 2026, in the Journal of Pediatric Urology.

LIMITATIONS

The cohort size was relatively small. A proportion of children were lost to follow-up because the institution served as a tertiary referral center and postoperative care was often continued by local physicians.

DISCLOSURES

This study did not receive any specific funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.