Ureteroceles are congenital malformations often found in patients with duplex renal collecting systems. They are associated with vesicoureteral reflux (VUR), which can be congenital or acquired after ureterocele puncture. When symptomatic VUR is present, two treatment options are available: ureteroureterostomy with reimplantation of the lower pole ureter (UU+UR) or common sheath reimplantation (CSR). This study aimed to compare the short- and long-term outcomes and VUR resolution rates between these strategies.

A retrospective review was conducted on pediatric patients diagnosed with a ureterocele and a duplex collecting system, and who had ipsilateral VUR, whether congenital or acquired, between 2005 and 2023. The patients were divided into two groups based on the surgical management of VUR: UU+UR or CSR. Short- and long-term complications, postoperative ipsilateral VUR, and the need for subsequent surgical interventions were compared using Fisher's Exact test.

Forty-six patients with duplex collecting systems, ureterocele, and ipsilateral VUR were identified. Seven patients who did not undergo any reflux correcting surgery were excluded, leaving a total of 38 patients (28 CSR, 10 UU+UR) for analysis. The average follow-up period was 21 months for CSR patients and 27 months for UU+UR patients. Among the UU+UR patients, 7 had no postoperative VUR, 1 had persistent VUR and required a redo ureteral reimplantation of the lower pole, and 2 did not have a postoperative voiding cystourethrogram. Among the CSR patients, 18 had no postoperative VUR, 4 had upper pole VUR, and 6 patients did not have postoperative voiding cystourethrograms. Among the CSR patients with persistent upper pole VUR, 3 required additional surgeries. One CSR patient achieved complete resolution of VUR but required an upper pole heminephrectomy due to recurrent urinary tract infections. No significant differences were found between the two groups in terms of short-term complications, long-term complications, VUR resolution, postoperative hydronephrosis, and the need for subsequent interventions.

In conclusion, both common sheath reimplantation and ureteroureterostomy with reimplantation are effective and safe strategies for urinary tract reconstruction in patients with duplex collecting systems and ureterocele. They have similar short-term and long-term outcomes.