Ureterocalicostomy: indications and results in 21 patients.

Ureterocalicostomy was performed in 21 patients for ureteropelvic junction obstruction. Ten patients had failed pyeloplasty, 10 had anomalies of renal fusion, ascent or rotation in conjunction with ureteropelvic junction obstruction and 1 had failed prior ureterocalicostomy. Patient age at operation ranged from 6 months to 17 years and averaged 9 years. Of the 21 patients in this series 19 had excellent results after ureterocalicostomy with decrease or total elimination of hydronephrosis. There were 2 postoperative complications in 2 patients: prolonged anastomotic urinary leakage in 1 and a Candida perinephric abscess in 1. Ureterocalicostomy should be considered in selected patients with previous unsuccessful pyeloplasty, ureteropelvic junction obstruction associated with anomalies of renal fusion, rotation or ascent, an intrarenal pelvis or a short ureter. Although endopyelotomy or ureteropelvic junction dilation should be considered in patients who fail pyeloplasty, ureterocalicostomy continues to be a reliable salvage procedure in these patients; it bypasses extensive peripelvic scarring, provides for dependent drainage and compensates for lack of adequate ureteral length.