DOI: 10.1177/08927790261461242 ISSN: 0892-7790

Comparison of Appendiceal Onlay Ureteroplasty and Appendiceal Interposition Ureteroplasty for Complex Proximal Ureteral Strictures in Children: Insights Gained from Long-Term Follow-Up

Jianhua Wen, Xiaoguang Zhou, Hualin Cao, Zelin Cui, Bowen Liu, Nini An, Yanfang Yang, Qian Zhang, Yun Zhou, Dehong Liu, Huixia Zhou, Pin Li
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Purpose:

Compare the long-term effectiveness of appendiceal interposition ureteroplasty (AIU) and appendiceal onlay ureteroplasty (AOU) in addressing complex proximal ureteral (CPU) strictures in children.

Patients and Methods:

A retrospective review of patients who underwent minimally invasive AIU and AOU for CPU strictures between March 2010 and August 2020. Patients were stratified into two groups based on the surgical technique: AIU group ( n = 11) and AOU group ( n = 29). Baseline characteristics, perioperative variables, and follow-up data were assessed in both groups.

Results:

All procedures were completed effectively without the need for conversion. There were no significant differences for the AIU versus AOU groups in median age at operation ( p = 0.686), disease side ( p = 0.715), preoperative split renal function of the affected kidney ( p = 0.906), type of surgical procedure (laparoscopy- vs robot-assisted, p = 0.498), and the mean stricture length ( p = 0.166). Operation time was significantly longer in the AIU group ( p < 0.001). There were no intraoperative complications, and the estimated blood loss ( p = 0.579), postoperative hospital stay ( p = 0.557), and Grade I–Ⅱ complications (AIU: 8/11 vs AOU: 18/29, p = 0.715) were similar between the two groups. At a median follow-up of 6 years, the success rates for the AOU group were significantly higher than the AIU group (96.6% vs 54.6%; p = 0.004).

Conclusion:

AOU is a safe and effective technique for managing CPU strictures in children, whereas AIU is not recommended for pediatric patients because of its potential for decreased success rates over time, primarily because of complications such as anastomotic stenosis and progressive hydronephrosis.

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