Ureteral Stump Research Articles

DISTAL URETERAL STUMP: CASE REPORT

Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren’t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

DISTAL URETERAL STUMP : CASE REPORT

Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren’t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

Forgotten stone in a ureteral stump increased the risk of an ureterocutaneous fistula

Here we report a female patient with diabetes who underwent right nephrectomy 18 years ago for pyonephrosis and renal stone formation. Before she was performed the right nephrectomy, a ureteral calculus impacted in the right ureteral stump was diagnosed. However, after 18 years, a right ureterocutaneous fistula was diagnosed, and the calculus was still found in the ureteral stump of the patient. As a result, a fistula caused by the ureter-impacted calculus was highly suspected. We successfully performed a right ureterectomy, fistulectomy, and debridement on the patient. From our experience in this case, we strongly recommend that a calculus impacted in the ureteral stump should be removed to prevent the occurrence of postoperative complications such as ureterocutaneous fistula.

Cox-2 gene overexpression in ureteral stump urothelial carcinoma following nephrectomy for renal cell carcinoma: a case report.

IntroductionA primary ureteral stump tumor after a nephrectomy is rare; urothelial carcinoma of the ureteral stump after a nephrectomy for renal cell carcinoma is even rarer. A thorough review of the literature indicated that only seven cases have previously been reported. In this study, we report the first Taiwanese case of urothelial carcinoma of the ureteral stump after a nephrectomy. It is also the first female case in the literature. The relationship between inflammatory genes, medication history and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma has not been reported.Case presentationA 72-year-old Asian Taiwanese women with chronic hepatitis C, liver cirrhosis and chronic kidney disease underwent a hand-assisted laparoscopic radical nephrectomy in 2001 due to renal cell carcinoma. Nine years later, she was diagnosed with ureteral stump urothelial carcinoma. Genetic and medication surveys were performed. Importantly, our patient had taken Chinese herbal drugs for more than 10 years and the inflammatory gene, Cox-2, was highly expressed in this patient. This is the first report to study the relationship between the Cox-2 gene and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma.ConclusionLong-term multiple use of Chinese herbal drugs could be one of the important risk factors for developing urothelial cancer. Close functional coupling between Chinese herbal drugs, Cox-2 gene activation and urothelial cancer should be further investigated.

Empyema of the Ureteral Stump after Nephrectomy Mimicking Pyosalpinx or Pelvic Cystic Tumor: Report of Two Cases

Empyema of the ureteral stump following a nephrectomy is a rare disease. We report on two cases of ureteral stump empyema in female patients who presented with a cystic mass in the pelvic cavity and a past history of a nephrectomy. CT and radiological findings indicated that the cystic lesion was a ureteral stump lesion, and was surgically proven as ureteral stump empyema in both cases.

Nephrectomy and upper pole heminephrectomy for poorly functioning kidney: Is total ureterectomy necessary?

Objective:We analyzed our experience with nephrectomy and upper pole heminephrectomy combined with subtotal ureterectomy to determine the incidence of the problems associated with the distal ureteral stump.Materials and Methods:The records of 48 children who underwent nephrectomy or upper pole heminephrectomy with subtotal ureterectomy for a poorly functioning kidney were reviewed.Results:No patient who underwent nephrectomy for a poorly functioning single-system kidney required secondary surgery. No secondary surgery was required in any patient who underwent upper pole heminephrectomy for ectopic ureter, while secondary surgery was required in five of 17 patients (29%) who underwent upper pole heminephrectomy for ectopic ureterocele. All five patients presented with recurrent febrile urinary tract infection after upper pole heminephrectomy. They also had reflux into the ipsilateral lower moiety, contralateral kidney, or distal ureteral stump. Our results and data from other reports suggest that recurrent urinary tract infections after upper pole heminephrectomy were treatment outcomes based on the initial surgical approach to ectopic ureterocele rather than isolated problems associated with the distal ureteral stump.Conclusion:We consider that total ureterectomy is unnecessary at the time of nephrectomy or heminephrectomy for a poorly functioning kidney because the distal ureteral stump rarely causes a problem.

Urothelial tumor development at the ureteral stump 25 years after simple nephrectomy

Urothelial tumor development at the ureteral stump 25 years after simple nephrectomy

Mesonephric adenoma in remnant ureteric stump: A rare entity

Nephrogenic Adenomas have been reported though out the Urinary Tract from Renal Pelvis to the Urethra. We present one rare case of its occurrence in the remanant ureteral stump.

Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys

To report our experience with laparoscopic heminephrectomy (LHN) in children with duplex kidneys, highlighting the late outcomes, including anatomical and functional aspects. We retrospectively analysed the medical records of 17 children (18 renal units) with duplex kidneys who underwent LHN (15) and heminephroureterectomy (three). Before surgery, all patients were evaluated using ultrasonography, voiding cysto-urethrography, computed tomography or magnetic resonance imaging with urography, and nuclear scintigraphy. After surgery patients were evaluated using ultrasonography and nuclear scintigraphy, and by voiding cysto-urethrography if there was a refluxing ureter. All laparoscopic surgery (17 transperitoneal and one retroperitoneal approach), were completed as planned with no intraoperative complications. Complications after surgery included prolonged urine leakage from a refluxing ureteric stump in one heminephroureterectomy, and a complete functional loss of the remnant pole in one retroperitoneal LHN. The function of the remnant pole was preserved in 17 patients (94%); in these 17 the mean decrease in renal function was 2.8%. Follow-up ultrasonography showed asymptomatic cystic structures in six patients. There was an asymptomatic remnant ureteric stump in two cases (one refluxing, one nonrefluxing). The loss of function caused by surgery is subtle but some remnant pole will be fully lost while experience is gained. Because the functional impairment due to vasospasm or vascular injury might not be recognized, all remnant kidneys must be evaluated using postoperative nuclear scintigraphy.

Laparoscopic Ureteropyeloanatomosis in the Treatment of Duplex Kidneys

Purpose To present our experience in the laparoscopic management of duplex kidneys with functioning upper units (UU) associated to ureterocele or ureteral ectopy. Material and Methods Four girls were diagnosed with duplex kidneys, three with urinary leakage and one with febrile UTI. All presented dilated, albeit functioning UUs, three with ectopic ureter, one with ureterocele. All were submitted to transperitoneal laparoscopy, preceded by insertion of DJ stent in the ipsilateral lower unit. After colonic mobilization and kidney exposure, the ureters were isolated. The ureter of the UU was sectioned and spatulated at the level of the lower kidney pole. The ureter of the lower unit (LU) was dissected to the pelvis, that was incised longitudinally, exposing the DJ stent. In one case, the pelvis was intrahilar, and the incision was performed in the proximal ureter. The end-to-side anastomosis between the spatulated UU ureter and the incised pelvis or ureter of the LU was performed with running 5.0 Vycril. No drains were left. The bladder catheter was removed after two days, and the DJ stent after three weeks. Results All patients were dry after the procedure, and none presented voiding symptoms or UTI. US, IVP and DMSA controls showed stable function of the LU, with improved function and decreased dilatation of the UU. There were no complications related to the lower ureteral stump. Conclusions Laparoscopic pyelo-ureteral anastomosis can be considered gold standard in the treatment of duplex kidneys with obstructed, but functioning UU associated to ureterocele or ureteral ectopy.

Empyema of the Ureteral Stump. An Unusual Complication Following Nephrectomy

A ureteral stump, which is the segment of the ureter left in place after nephrectomy, may occasionally give rise to a pathologic process called ureteral stump syndrome, which is clinically interpreted as febrile urinary tract infections, lower quadrant pain, and hematuria. Empyema of the ureteral stump, which belongs to this syndrome, is an uncommon disease entity presenting with a reported incidence of 0.8–1%. We present a case of empyema of the ureteral stump in a female patient 5 years postnephrectomy for a nonfunctioning kidney, and discuss the clinical presentation, radiologic diagnosis, and therapeutic options of this uncommon disease entity.

Single-Incision Transureteral Laparoscopic Nephrectomy: A Proof of Concept

Single-umbilical incision laparoscopic nephrectomy has been recently advocated as an alternative to pure natural orifice transluminal endoscopic surgery. We present a novel, hybrid technique for laparoscopic nephrectomy that combines single-incision laparoscopy with natural orifice transluminal endoscopic surgery principles consisting of using the ureteral stump as a natural orifice. Six renal units were operated in a nonsurvival pig study by combining a single umbilical incision with a novel natural orifice, the divided ureter. A transurethral 16F Amplatz sleeve inserted in the ureter under cystoscopic guidance became a natural orifice port after transection of the ureter. Regular laparoscopic instruments and scopes were used through two adjacent single-incision umbilical ports. The camera was placed in one of the umbilical ports and two operating instruments were introduced through the additional umbilical port and the "natural orifice port," respectively. Right and left laparoscopic nephrectomy were successfully performed. No complications occurred except one case of a periureteral hematoma due to the dilation of the ureter. The hylar blood vessels were thoroughly dissected and controlled by either clips or vascular staplers. The operative time decreased from 140 minutes in the first procedure to 70 minutes in the last (median time: 85 minutes). The learning curve was short because the basic principles of laparoscopy such as correct instrument angulation and geometry could be achieved through the inferior, natural orifice port. Laparoscopic nephrectomy combining a single umbilical incision with a natural orifice provided by the ipsilateral ureter is technically feasible in a large animal model. Further studies in human patients together with assessment of advantages over classic laparoscopic nephrectomy are needed.

Prone retroperitoneoscopic approach for heminephrectomy: Specific advantages relating to access to vascular pedicle

The lateral approach is more widely used in retroperitoneoscopic (RP) heminephroureterectomy (HNU) due to familiar orientation and ease of conversion. The prone approach however gives early and easy access to the vascular pedicle. The main reason for not adopting a prone approach more widely is the perceived difficulty in lower ureteric access. We present a series of 30 HNUs where the prone approach was utilized extremely effectively with no conversions and few complications. Thirty consecutive HNUs performed over a 4-year period (2004-2007) using a prone RP approach were included in the study. Prospectively recorded data and notes were reviewed. Upper HNU was done in 17 and lower HNU in 13 patients. Mean age was 3.2 years (range 0.9-13.3). There were no transfusions or conversions. Follow-up ultrasound showed healthy remnant moieties in all. Residual ureteric stump was seen in six patients but only one was symptomatic requiring a further procedure. With the prone approach the anatomy can be demonstrated quickly and effectively. Dissection can be done easily without the need for kidney retraction as gravity aids demonstration of the renal vascular pedicle. There is a low risk of complications arising from the residual ureteric stump. We recommend that this approach be considered for RP HNU in all patients, irrespective of age.

Fistulization between ectopic ureteral stump and uterus following nephroureterectomy: case report

Ureterouterine fistulas are rare surgical complications with fewer than 30 reported cases in the literature to date. Rarer yet is a fistula between an ectopic ureter and the uterus, with only one case described previously (Shibata et al. in J Urol 153: 1208-1210, 1995). Herein, we present the first case, to our knowledge, of a fistula between an ectopic ureteral stump (from a prior nephroureterectomy) and the uterus.

Robotic pediatric urology

Robotic-assisted minimally invasive surgery is penetrating pediatric urology. The freedom afforded by the "surgical actuators" has led to the expanding adoption of robotics, and it is unlikely that much of laparoscopy will not trend toward some iteration of robotic influence. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) provides delicate telemanipulation, coalesced with three-dimensional visualization and superior magnification. It has bridged the gap between laparoscopy and open surgery. Nonetheless, a confident understanding of pure laparoscopy is paramount in the event that mechanical malfunction is experienced. Robotic pediatric urologic procedures such as pyeloplasty, ureteral reimplantation, abdominal testis surgery, and partial or total nephrectomy with or without ureteral stump removal are routinely performed at select centers offering robotic expertise. Complex reconstructive surgeries such as appendicovesicostomy, antegrade continent enema creation, and augmentation cystoplasty can be performed but are still in their infancy.

Empyema of Retained Ureteral Stump With Gross Stone 20 Years After Nephrectomy

We present a rare case of empyema of the ureteral stump with a large calculus 20 years after nephrectomy for a nonfunctioning kidney secondary to chronic obstruction resulting from a small ureteral stone. The ureteral stump with stone was removed en bloc. We suggest that a ureter with stone should be excised at nephrectomy, especially in cases with a dilated ureter.

Ureteral stump transitional cell carcinoma after radical nephrectomy: A case report with review of literature

Primary transitional cell carcinoma (TCC) of the ureter accounts for less than 1% of all malignancies of upper genitourinary tract .Ureteral stump after radical nephrectomy may develop malignancy very rarely, TCC being the commonest. Definite risk exists if the urinary bladder harbored TCC. Presence of TCC of the urinary bladder and persistent urinary tract infections in a nephrectomized patient may indicate closer evaluation.

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

Adenocarcinoma primario en un remanente ureteral tras una nefrectomía simple

AimAdenocarcinomas of the upper urinary tract are very rare malignancies often related to primary genitourinary and extraurinary tumours. Primary adenocarcinomas are even rarer. There are no clinical guidelines for the management of primary ureteral adenocarcinoma. Our objective is to propose a management algoritm of this sort of tumours. MethodsWe report a case of adenocarcinoma affecting a ureteral stump in a patient who previously underwent a nephrectomy. A review of literature is performed. ResultsAfter the ureterectomy the pathologist diagnosed a ureteral adenocarcinoma. We performed an extension study in order to discard an extraurinary origin. ConclusionsAdenocarcinoma of the ureteral stump is a very rare malignancy. About the clinic and pathologic characterization, there is no an established reference due to the short number of previous reports. Clinical presentation may include previous nephrectomy, flank pain, dysuria, urgency and/or gross hematuria. It seem necessary the complete resection of the urinary tract when a nephrectomy is performed. Adjuvant chemotherapy can be employed with uncertain results.

Robot-Assisted Ureterectomy and Ureteral Reconstruction for Urothelial Carcinoma

Urothelial carcinoma of the distal ureter can be managed by ureterectomy followed by reconstruction of the urinary system. We review our experience with robot-assisted ureterectomy. Nine consecutive patients who were candidates for ureterectomy underwent robot-assisted surgery between 7/8/2005 and 7/25/2006. Patient characteristics, intraoperative parameters, and short-term outcomes were retrospectively reviewed. Mean operative time was 252 minutes. The mean blood loss was 44 mL, and no patient needed a transfusion. The mean hospital stay was 1.5 days. Six patients needed a psoas hitch; one patient each underwent a primary ureteral anastomosis, a direct ureteral reimplant into the dome of the bladder, and distal ureterectomy for tumor in a ureteral stump after nephrectomy. The ureteral reimplant was performed intravesically in one patient and extravesically in five patients. A bladder cuff was excised in all patients who were undergoing a distal ureterectomy. All surgical margins were negative, and five patients had high-grade tumor. A ureteral stricture developed in one patient, and a patient experienced aspiration pneumonia in the postoperative period. Robot-assisted ureterectomy and ureteral reconstruction is safe and feasible, and offers patients the advantages of minimally invasive surgery. Future studies with additional patients and longer follow-up will determine the oncologic effectiveness of this procedure.