One Trocar-assisted Retroperitoneoscopic Ureteroureterostomy for Ureteral Duplication

NCT ID: NCT06350942

Last Updated: 2024-04-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

40 participants

Study Classification

OBSERVATIONAL

Study Start Date

2016-09-30

Study Completion Date

2024-02-29

Brief Summary

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Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children.

Detailed Description

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Ureteral duplication, a common anomaly affecting about 0.8% of the population, presents challenges in pediatric urology due to its diverse clinical presentations and anatomical complexity. Traditional treatments like upper pole moiety (UPM) heminephrectomy can lead to loss of renal function in the remaining lower pole moiety (LPM). Ureteroureterostomy (UU) is a safer alternative, increasingly preferred regardless of renal function or reflux presence. Minimally invasive techniques like laparoscopic and robotic procedures show promise, but robotic-assisted UU is costly, while laparoscopic UU has technical challenges. A novel approach is proposed: single-trocar retroperitoneoscopic-assisted UU, combining laparoscopic visualization advantages with simplified extracorporeal suturing, offering a promising solution for managing complete ureteral duplication. The present study was designed to describe the operative technique and outcome of OTAU in 40 cases of complete ureteral duplication in children.

Demographic data of patients, their clinical manifestations, classification of hydronephrosis based on the guidelines established by the Society for Fetal Urology (SFU), dimensions of the renal pelvis measured in the anterior-posterior direction (APD), diameters of the ureters, duration of surgical procedures, duration of hospitalization, and subsequent follow-up information were systematically gathered prospectively to evaluate the long-term outcomes of the proposing surgical technique.

Conditions

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Ureteral Duplication

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Complete duplicated collecting system

The presence of two pelvicalyceal systems within a single kidney, with either obstructed or ectopic ureter

one trocar-assisted retroperitoneoscopic ureteroureterostomy (OTAU)

Intervention Type PROCEDURE

A 12 mm transverse incision was made just above the iliac crest, followed by careful dissection of the fascia and muscle layer to expose the Gerota's fascia. Entry into the retroperitoneal space was achieved with a 10-mm balloon trocar, allowing for pneumoretroperitoneum establishment. Using a 10-mm laparoscope equipped with a Maryland dissector, the ureters were dissected and isolated, followed by careful exteriorization of both upper and lower pole moiety ureters with a Babcock grasper. The pathological upper pole moiety ureter was transected, preserving the normal lower pole moiety ureter and shared blood supply, and closed with a Vicryl 4/0 suture. Subsequently, an end-to-side ureteroureterostomy was performed with a 6/0 Polydioxanone running suture, with antegrade insertion of a double J stent if not previously conducted. A final retroperitoneoscopic evaluation ensured proper anastomosis alignment, and the incision was closed without drainage.

Interventions

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one trocar-assisted retroperitoneoscopic ureteroureterostomy (OTAU)

A 12 mm transverse incision was made just above the iliac crest, followed by careful dissection of the fascia and muscle layer to expose the Gerota's fascia. Entry into the retroperitoneal space was achieved with a 10-mm balloon trocar, allowing for pneumoretroperitoneum establishment. Using a 10-mm laparoscope equipped with a Maryland dissector, the ureters were dissected and isolated, followed by careful exteriorization of both upper and lower pole moiety ureters with a Babcock grasper. The pathological upper pole moiety ureter was transected, preserving the normal lower pole moiety ureter and shared blood supply, and closed with a Vicryl 4/0 suture. Subsequently, an end-to-side ureteroureterostomy was performed with a 6/0 Polydioxanone running suture, with antegrade insertion of a double J stent if not previously conducted. A final retroperitoneoscopic evaluation ensured proper anastomosis alignment, and the incision was closed without drainage.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Clinical diagnosis of ureteral duplication.
* Age no more than 18 years old
* The surgical technique performed must be one trocar-assisted retroperitoneoscopic ureteroureterostomy.
* Followed up at least 2-4 years

Exclusion Criteria

* Patients exhibiting reflux to the ureter of the lower pole moiety (LPM)
* Patients with prior urologic surgeries or other urological anomalies
Minimum Eligible Age

1 Month

Maximum Eligible Age

10 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Vinmec Research Institute of Stem Cell and Gene Technology

OTHER

Sponsor Role collaborator

National Children's Hospital, Vietnam

OTHER

Sponsor Role lead

Responsible Party

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Nguyen Thanh Quang

Pediatric Surgeon

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Quang T Nguyen, M.D.

Role: PRINCIPAL_INVESTIGATOR

: Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam

Locations

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The National Hospital of Pediatrics

Hanoi, , Vietnam

Site Status

Vinmec Research Institute of Stem Cell and Gene Technology

Hanoi, , Vietnam

Site Status

Countries

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Vietnam

References

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type RESULT
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Reference Type RESULT
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Lee NG, Corbett ST, Cobb K, Bailey GC, Burns AS, Peters CA. Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population. J Endourol. 2015 Nov;29(11):1237-41. doi: 10.1089/end.2015.0223. Epub 2015 Aug 21.

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Liem NT, Dung LA, Viet ND. Single trocar retroperitoneoscopic assisted ipsilateral ureteroureterostomy for ureteral duplication. Pediatr Surg Int. 2012 Oct;28(10):1031-4. doi: 10.1007/s00383-012-3158-7. Epub 2012 Aug 12.

Reference Type RESULT
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Reference Type RESULT
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Other Identifiers

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1451_01/BVNTW-VNCSKTE

Identifier Type: -

Identifier Source: org_study_id

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