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CC BY 4.0 · European J Pediatr Surg Rep. 2023; 11(01): e10-e14
DOI: 10.1055/a-2035-4637
Case Report

Upper Ureteral Reconstruction with a Tapered Descending Colon after Failed Pyeloplasties in a 13-Year-Old Boy

Hideaki Nakajima 
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
2   Department of Pediatric Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
,
Hiroyuki Koga
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Seitaro Kosaka 
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Mao Ikari
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Geoffrey J. Lane
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Atsuyuki Yamataka
1   Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Abstract

An 11-year-old boy was referred for further management of a 6-cm-long grossly stenosed ureter following two failed left ureteropelvic junction (UPJ) obstruction repairs elsewhere. A tapered segment of the descending colon (TDC) was used successfully for ureteral reconstruction. The UPJ was exposed through a left flank incision. The stenosed segment was excised; both ends appeared severely inflamed and thickened. Tissue interposition was required and ureteroplasty with a TDC was performed by incising the peritoneum adjacent to the excised ureter to mobilize the descending colon to the retroperitoneal space. To prepare the TDC, an 8-cm segment of the colon with intact blood vessels was isolated, tapered, and sutured into a funnel shape using a 14-Fr catheter as a temporary stent. After colocolostomy, the colon was returned to the abdominal cavity, the peritoneum was closed carefully to prevent vascular compromise, and the TDC was anastomosed to the ureter and renal calyx with interrupted absorbable sutures. A double J stent (DJS) and percutaneous nephrostomy tube were placed. Postoperative recovery was uneventful. The DJS was removed on day 50 after confirming smooth urine flow through both the ureter–TDC and calyx–TDC anastomoses. Diuretic renography performed 68 days postoperatively was unobstructed. The patient is currently well after 12 months follow-up. This would appear to be the first report of a TDC being used to create a funnel-shaped segment to reconstruct a long, grossly stenosed ureter. The TDC is simpler than the re-tubularizing colon but requires monitoring for postoperative mucus-related complications and malignant transformation.

Keywords

ureteral reconstruction - ureteropelvic junction obstruction - tapered segment of the descending colon - long ureteral stenosis


Publication History

Received: 02 June 2022

Accepted: 08 February 2023

Accepted Manuscript online:
14 February 2023

Article published online:
10 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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