LONg TERM OuTCOMES OF SuRgICAL MANAgEMENT IN PATIENTS WITH INTRAvESICAL juNCTION OBSTRuCTION

Aim: ureterovesical junction obstruction (uvjO) is the second most common cause of hydronephrosis in newborns, with an estimated incidence of 36 per 100000 live births. This study aimed to assess long term outcomes of intravesical junction obstruction who underwent surgery.
Methods: 19 patients with uvjO operated in our instutition between 2007 and 2017 were retrospectively reviewed. Demographical data, ureter diameter, differantial function(DF), clinical outcomes were recorded. Cohen ureteroneocystos- tomy was performed in all patients. For ureters larger than 10 mm in diameter, ureteral tapering was performed with Hendren technique. Preoperative studies included ultrasound scan, voiding cystourethrography, and diuretic isotopic renogram. Wilcoxen nonparametric test was used for stastistical analysis.

Results: 16 (12M/4 F) patients with eligible follow up period participated in the present study. Mean age of the patients was 33 months (6-120 months). Four patients were operated under one year of age. Mean preoperative follow-up period was 11 months (2-24 months). uvjO was on the in 9 patients (%56.25), on the right in 4 patients (%25) and bilateral in 3 patients (%18.75). The mean distal ureteric diameter was 15.9 mm and the mean renal pelvis anteroposterior diamater (APD) was 17.5 mm before surgery. The mean preoperative DF was 35,6±16 % and found 35.5±13 % postoperatively (p=0.937) for patients who had unilateral uvjO. Tapering was performed in 14 patients (15 ureters). Distal ureter diameter was normal in postoperative follow-up in fourteen patients and decreased in 5 (mean 7.7 mm). There were no peroperati- ve or early postoperative complications. One patient was reoperated because of ongoing obstruction after the surgery (6.25%). Only two patients had uTI more than once in early postoperative period as a minor complication. No patient had lower urinary truct disfunction (LuTD) or hypertansion in follow-up (mean 8,5 years). Overall success rate was 93.75%. Discussion: It is well-known that the majority of congenital megaureters may be managed conservatively. But surgical intervention is necessery in some patients. British Association of Paediatric urologists (BAPu) recommended ureteral reimplantation in over 1 year of age but recognized that the procedure may be challenging in infancy.

Conclusions: For uvjO, intravesical ureteric reimplantation together with resection of the stenotic segment and tapering if required, is a safe and effective procedure.