Dagash H et al. (2008) The appendix as ureteral substitute: a report of 10 cases. J Pediatr Urol 4: 14–19

Ureteral replacement is rarely necessary in children, and various surgical procedures have been described for this purpose. One such procedure involves the use of the appendix as a ureteral substitute; however, only isolated reports of this approach exist in the literature. In their paper published in the Journal of Pediatric Urology, Dagash and colleagues have documented the largest series to date of patients treated with this approach.

The authors reviewed case notes on 10 children from three centers in the UK and India. Mean age at surgery was 2.5 years (range 2.5 months to 12 years). The appendix was substituted for the right ureter in nine patients, and for the left ureter in the remaining child. In all patients, the appendix was positioned in an antiperistaltic orientation and anastomosed to the renal pelvis via a cecal cuff. The underlying conditions necessitating ureteral replacement were congenital ureteral stenosis (n = 5), nondrainage following pyeloplasty (n = 3), traumatic ureteral avulsion (n = 1) and stricture following ureteral reimplantation for vesicoureteral reflux (n = 1). Median duration of follow-up was 16 months (range 1–72 months).

Following surgery, renal function was preserved in nine children. In the remaining child, a 2-year-old boy with right ureteral stricture and only 36% preoperative right differential renal function, the right kidney was nonfunctional at 8 months. The authors conclude that the appendix can safely and effectively be used as a ureteral substitute in children, even very young babies.