Surgical Management of Pediatric Ureteral Anomalies

Pediatric ureteral anomalies encompass a spectrum of congenital malformations, including duplex collecting systems, ectopic ureters and ureteroceles, which may present with urinary tract infections, hydronephrosis or incontinence. Early and accurate imaging—using ultrasound, voiding cystourethrography and magnetic resonance urography—underpins surgical decision-making by delineating anatomy and function. Endoscopic decompression of obstructive ureteroceles has become a first-line intervention, reducing upper tract pressure and infection risk while deferring more extensive reconstruction. In duplex systems, preservation of healthy renal tissue guides the choice between heminephrectomy of a dysplastic pole and reconstructive approaches such as ureteroureterostomy or common sheath reimplantation. Minimally invasive techniques, notably laparoscopy and robot-assisted surgery, have transformed outcomes by shortening hospital stays, minimising postoperative pain and improving cosmetic results. Critical considerations include the presence of vesicoureteral reflux, accessory vessels and patient age. Risk stratification for adverse events—such as ureteral obstruction, leakage or recurrent infection—relies on anatomical factors and surgeon experience. Globally, advances in surgical optics, energy devices and suturing technologies have fostered multidisciplinary collaboration between paediatric urologists and radiologists, ensuring interventions are tailored to individual anatomical variants and functional goals while preserving long-term renal health.

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Surgical Management of Pediatric Ureteral Anomalies publication trend

The graph below shows the total number of articles in surgical management of pediatric ureteral anomalies across all publications each year (not limited to Nature Index journals).

Technical terms

Duplex collecting system: A kidney with two separate pelvicalyceal systems and ureters.

Ectopic ureter: A ureter that drains outside its normal insertion on the bladder trigone.

Ureterocele: Cystic dilation of the distal ureter within the bladder wall causing obstruction.

Laparoscopic ureteroureterostomy (LUU): Minimally invasive anastomosis of two ureteral segments to bypass obstruction.

Heminephrectomy: Surgical removal of a non-functioning moiety of a duplex kidney.

Vesicoureteral reflux (VUR): Retrograde flow of urine from the bladder into the ureters and renal pelvis.

References

1. Laparoscopic Ureteroureterostomy vs. Common Sheath Ureteral Reimplantation in Children With Duplex Kidney Anomalies. Frontiers in Pediatrics (2021).
2. Minimally Invasive Laser Treatment of Ureterocele. Frontiers in Pediatrics (2019).
3. Laparoscopic Heminephrectomy for Duplex Kidney in Children—The Learning Curve. Frontiers in Pediatrics (2019).
4. Risk factor of postoperative adverse events among children with duplex kidney undergoing upper pole heminephrectomy: a single-center experience. Frontiers in Pediatrics (2024).