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Risk factors for postoperative adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic ureterocele associated with the duplex system

  • Xiaoming Yin
    Affiliations
    Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China
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  • Yi Yang
    Correspondence
    Corresponding author. Yi Yang, No.36 Sanhao Street, Heping district, Shenyang city, Liaoning province 110004, China. Tel.: +860249661557411; Fax: +8602464653696
    Affiliations
    Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China
    Search for articles by this author
Published:October 18, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.022

      Summary

      Introduction

      Ectopic ureterocele management in children remains a controversial subject without a clear consensus. The purpose of this study was to explore the risk factors for adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic duplex system ureterocele, a complex urinary system deformity with controversial treatment.

      Materials and methods

      We retrospectively reviewed 75 patients with unilateral ectopic duplex system ureterocele who underwent surgery at the Shengjing Hospital of China Medical University between January 1, 2008, and September 31, 2020. Demographic characteristics, preoperative data, surgical procedures, postoperative adverse outcomes, and secondary surgery were recorded. Adverse outcomes were defined as new-onset VUR and BOO after surgery. The risks of adverse outcomes and secondary surgery were evaluated using multivariate binary logistic regression and expressed as adjusted odds ratios with 95% confidence intervals.

      Results

      Adverse outcomes occurred in 25 (33.3%) patients, including 24 (32.0%) with new-onset vesicoureteral reflux and 1 (1.3%) with bladder outlet obstruction. Seven (9.3%) patients required secondary surgery. The independent risk factors for adverse outcomes were transurethral endoscopic incision and transurethral endoscopic puncture (transurethral endoscopic incision vs. upper pole partial nephrectomy: OR = 11.049, P = 0.004; transurethral endoscopic puncture vs. upper pole partial nephrectomy: OR = 33.222, P = 0.002).

      Discussion

      The definitive treatment for duplex system ureterocele remains controversial. We found that transurethral endoscopic incision or puncture was an independent risk factor for adverse outcomes. The main limitation of this study would be its retrospective nature and relatively short follow-up period. Furthermore, 30 children were younger than 5 years at last follow up, and thus, we could not efficiently evaluate their voiding function.

      Conclusions

      Summary TableMultivariate binary logistic regression analysis of the risk factors for adverse outcomes and secondary surgery.
      Variables Multivariate binary logistic regression of adverse outcomes Multivariate binary logistic regression of secondary surgery
      OR 95%CI P-value OR 95%CI P-value
      Age at operation (<6 months vs. ≥6 months) 0.720 0.144–3.606 0.689 4.646 0.537–40.165 0.163
      Preoperative SRF of upper moiety 0.969 0.889–1.057 0.483 1.013 0.899–1.142 0.832
      Maximum diameter of ureterocele 0.966 0.899–1.038 0.350 0.945 0.851–1.051 0.297
      Preoperative fUTI (yes vs. no) 0.545 0.151–1.964 0.353 0.953 0.137–6.606 0.961
      Time of diagnosis (antenatal vs. postnatal) 1.679 0.303–9.303 0.553 - - 0.998
      Procedures UPPN (Reference)
       TUI 11.049 2.148–56.822 0.004 2.087 0.158–27.554 0.576
       TUP 33.222 3.654–302.062 0.002 2.275 0.095–54.266 0.612
       CSR - - 0.999 - - 0.999
      OR, odds ratio; CI, confidence interval; SRF, split renal function; fUTI, febrile urinary tract infection; TUI, transurethral endoscopic incision; TUP, transurethral endoscopic puncture; CSR, common sheath reimplantation; UPPN, upper pole partial nephrectomy.

      Keywords

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