Wrap plication of megaureter around normal-sized ureter for complete duplex system reimplantations

J Urol. 2013 Jan;189(1):295-9. doi: 10.1016/j.juro.2012.09.004. Epub 2012 Nov 20.


Purpose: A duplex collecting system is a common congenital renal tract abnormality associated with different clinical problems. We describe our experience with ureteral reimplantations of a complete duplex collecting system where 1 megaureter needing recalibration and 1 normal-sized ureter coexisted. Recalibration of the megaureter was done by wrap plication around the normal-sized ureter.

Materials and methods: Operative logs and case notes were reviewed of consecutive children with a complete duplex collecting system treated with wrap plication of the megaureter around the normal-sized ureter and reimplantation between 1997 and 2010. Reoperation, vesicoureteral reflux and obstruction rates were assessed.

Results: A total of 25 children underwent wrap plication and ureteral reimplantation. Of the cases 19 (76%) were completely successful and 6 (24%) needed reoperation. Three children (12%) had persistent high grade vesicoureteral reflux, 2 (8%) underwent endoscopic correction and 1 (4%) underwent repeat reimplantation of the duplex system. Three children (12%) had postoperative obstruction and 2 (8%) underwent endoscopic incision of the ureteral orifice. In 1 child (4%) a nonfunctioning lower moiety of the kidney developed, which was managed by heminephrectomy.

Conclusions: Wrap plication of a megaureter around the normal-sized ureter before reimplantation seems to be a relatively safe method in the surgical management of children with a complete duplex collecting system of the kidney. Sufficient spatulation of the lower pole ureter seems to be crucial.

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Replantation
  • Retrospective Studies
  • Ureter / abnormalities*
  • Ureter / surgery*
  • Urologic Surgical Procedures / methods