Postoperative Breakthrough Infection and Re-operation in Patients with Duplicated Collecting Systems: A Comparative Analysis of Surgical Outcomes

Abstract

Objective: The purpose of surgical intervention for ureteral duplication is to decrease the risk of infections, preserve renal function and avoid bladder dysfunction. The objective of this study was to determine if there is a difference in outcome between total reconstruction of the urinary tract, an upper tract approach, or a lower tract approach.

Materials and Methods: The outcomes of partial nephrectomy, common sheath re- implantation, total reconstruction and transurethral incision of ureterocele were pooled and compared against each other. Primary outcome criteria included breakthrough infection, voiding dysfunction and need for a second surgery. Procedural dependence of the primary outcomes for each surgery was analyzed using Chi square test. Odds ratio was then computed for each procedure with total reconstruction as the standard. Logistic regression analysis of the odds ratio was done to determine statistical significance.

Results: A total of 128 patients were included in the study. Breakthrough infection was seen in 18.8% of those who underwent partial nephrectomy, 23.8% of those who underwent re- implantation, 19.4% of those who underwent total reconstruction, and 46.4% of those patients who underwent TUI-U. Only 1 patient from the partial nephrectomy group and 1 patient from the total reconstruction group experienced voiding dysfunction. Of the 23 patients who underwent TUI-U, 5 (17.9%) needed a secondary procedure, while 3 from the partial nephrectomy, and none from the re-implantation and total reconstruction groups required re-operations. Analysis showed that breakthrough urinary tract infection is dependent on the type of procedure. Using total reconstruction as the standard, the odds ratio for partial nephrectomy is 0.962, 1.302 for common sheath re-implantation and 3.611 for TUIU. Logistic regression analysis showed statistical difference in the odds ratio of TUI-U and total reconstruction.

Conclusion: Breakthrough infection is shown to be dependent on the procedure. TUI-U has a 3.6-fold higher chance of breakthrough infection compared to total reconstruction, hence up to 18% of patients who opt for TUI-U should be counseled regarding the need for a secondary operation. The odds of breakthrough infection in common sheath re-implantation and partial nephrectomy is not significantly different from total reconstruction. No evidence was established regarding the dependence of reoperations and voiding dysfunction to the primary procedure.