MP71-03 DISTAL URETERAL STUMP COMPLICATIONS AFTER LAPAROSCOPIC NEPHRECTOMY OF A NONFUNCTIONING KIDNEY: A CONTEMPORARY SERIES

Abstract

You have accessJournal of UrologyPediatrics: Upper Urinary Tract Disorders and Fetal Urology (MP71)1 Apr 2020MP71-03 DISTAL URETERAL STUMP COMPLICATIONS AFTER LAPAROSCOPIC NEPHRECTOMY OF A NONFUNCTIONING KIDNEY: A CONTEMPORARY SERIES Roi Babaoff*, Paz Lotan, Chen Shenhar, and David Ben-Meir Roi Babaoff*Roi Babaoff* More articles by this author , Paz LotanPaz Lotan More articles by this author , Chen ShenharChen Shenhar More articles by this author , and David Ben-MeirDavid Ben-Meir More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000951.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laparoscopic nephrectomy of a nonfunctioning kidney due to vesicoureteral reflux may predispose to complications of the residual distal ureteral stump. However, the second intervention rate is low, and many surgeons are comfortable ligating the distal ureter and leaving it in situ. We sought to evaluate ureteral stump complications after laparoscopic nephrectomy for any benign etiology. METHODS: We retrospectively reviewed the records of all patients aged ≤18 years who underwent laparoscopic nephrectomy of a non-/poorly functioning kidney of benign etiology from February 2006 to October 2018. In line with departmental practice, nephrectomy included ligation of the ureter at the level of the pelvic brim. Data were collected on patient characteristics, surgical indications, and outcomes, and follow-up clinic visits and surgical interventions to October 2019. RESULTS: The cohort included 76 patients (29 girls, 38%) of median age 6.2 years (IQR 2.8-10.0). Median follow-up time was 5.2 years (IQR 2.6-9.4). Apparent causes of nephropathy were vesicoureteral reflux (n=29, 38%), multicystic nonfunctioning kidney (n=22, 29%), obstructive nephropathy (n=20, 26%), vascular disease (n=3, 4%), and dysplasia (n=2, 2.6%). Indications for nephrectomy, were recurrent urinary tract infections, high-grade vesicoureteral reflux, hypertension, mass effect, and nephrolithiasis, alone or in various combinations. During follow-up, 4 patients (5.3%; 3 boys, 1 girl) with recurrent urinary tract infections demonstrated ureteral stump reflux and underwent open stump excision. Three of them had prior high-grade reflux nephropathy, and one (male) had a non-refluxing dysplastic kidney, voiding dysfunction, and secondary ureteral stump reflux. The infections resolved postoperatively, and no other complications (e.g., stump intussusception, new voiding dysfunction) were reported. CONCLUSIONS: We noted a low (5.3%) rate of post-nephrectomy ureteral stump complications. Four patients required surgery, including 3/29 with reflux nephropathy, suggesting a 10% second intervention rate for that subgroup. Children with voiding dysfunction may acquire secondary distal ureteral stump reflux necessitating excision. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1064-e1065 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roi Babaoff* More articles by this author Paz Lotan More articles by this author Chen Shenhar More articles by this author David Ben-Meir More articles by this author Expand All Advertisement PDF downloadLoading ...