Revisiting ureteral substitution and its outcome in children: single centre 13 year experience

Background: Objective of this study is to explore various ureteric substitutes in pediatric age group and their outcomes.Methods: Retrospective analysis was done from 2003-2016, of all patients operated in this hospital that had undergone ureteral replacement. Thirteen such patients (5 from initially published paper (1) and 8 new patients) were followed up to find conduit patency, renal function and related complications with their outcomes assessed.Results: Ureteric substitution was done in 8 patients. Age of the patient ranged from 4 months to 8 years. Out of these for 2 patients monti tube was created; one with colon and other jejunum, rest of the 6 patient appendix was used. On follow up one patient had early appendico-ureteral leak requiring re-anastomosis and one patient had partial obstruction at 6 months corrected by dividing mesentry and untwisting appendix. With a mean follow up of 3.8 years all patients have preserved renal functions and drainage present. Also 5 patients of ureteral substitution performed at this institution and published prior were followed up with mean follow up of 10.4 years having no complaints with preserved function and unobstructed drainage.Conclusions: This small series supports that not only appendix and ileum but even colon as well as jejunum should be considered as Monti’s tube for ureteric replacement, when confronting with short ureter in paediatric age group.