Ureteric clipping for the treatment of urinary incontinence in girls with ectopic ureters: Predicting who is going to dilate and does it matter?

OBJECTIVES: To assess the effectiveness and midterm follow up of laparoscopic upper pole ectopic ureteral clipping to treat urinary incontinence in girls with duplex kidneys and non/poorly functioning upper pole moieties. To see if pre-operative characteristics increased the likelihood of significant post-operative dilatation and whether this dilation has clinical significance.

METHODS: A database review identified children who had undergone ureteric clipping at our institution. Patient details assessed included: age at presentation, age at procedure, significant past medical history, pre-operative investigations, operative time, length of stay, post-operative symptoms, post-operative renal tract ultrasound findings and the need for subsequent intervention.

RESULTS: Six girls underwent clipping between March 2018 - May 2021. The mean age at presentation and surgery were 77months (39-186) and 86months (44-193) respectively. The mean operative time was 94 minutes (range 66-128 minutes). The median length of stay was 1 day (range 0-3 days). All the girls were dry immediately after the procedure. During a mean follow up of 51 months (29-66) all children have remained symptom free and required no further intervention. Two children have developed significant (>30mm) but stable ureteric dilatation after clipping but have remained asymptomatic and therefore are continuing on conservative follow up. Both these children had dilated ureters (>10mm) pre operatively.

CONCLUSION: Ureteric clipping is quick, safe and effective option in dealing with incontinence due to ectopic upper pole ureters in girls. Children with pre-operative ureteric dilation seem to be at increased risk of post-operative dilation. However, as they remain asymptomatic, the clinical significance of this dilatation is unclear.