Ureteral Stump Research Articles

Laparoscopic partial nephrectomy in infants and toddlers

Background/Purpose The aim of this report is to assess the technique and outcome of laparoscopic partial nephrectomy in infants and toddlers. Methods From January 2001 to January 2005, 7 consecutive patients, ages 5 to 15 months, underwent laparoscopic partial nephrectomies. All patients had duplicated systems associated with ureteroceles (5), severe reflux (1), ectopic ureter (1), and nonfunctioning systems. Follow-up ranged from 4 to 51 months. Results All procedures were completed successfully using 4 ports (2 × 5 and 2 × 3 mm) except one, which required an additional port. The distal ureter, renal parenchyma, and hilar vessels were all transected using the harmonic scalpel. The mean operating time was 179 minutes with minimal blood loss in each case. The average hospital stay was 2.4 days (range, 1-5 days). The first case in the series, initially attempted retroperitoneally, was converted to a transabdominal approach because of lack of space. All subsequent approaches were transabdominal. One patient required ureteral stump reexcision because of frequent urinary tract infections associated with a distal ureteral diverticulum. Conclusions Laparoscopic partial nephrectomy can be performed safely. The harmonic scalpel divides the parenchyma bloodlessly. The cosmetic result is excellent. A transabdominal approach with division of the ureteral cuff flush with the bladder is recommended.

The use of refluxing ureter in the creation of a Mitrofanoff channel in children undergoing bladder augmentation: is a formal reimplantation necessary?

To study the fate of a refluxing ureteral stump used as a Mitrofanoff channel (MC) for clean intermittent catheterization (CIC), without reimplantation in augmented bladders. Ten boys and seven girls, 1-14 years old (mean 6.5 years) seen in period 1998-2005, underwent creation of MC using refluxing or potentially refluxing ureters. Concomitant bladder augmentation (BA) was performed for various abnormalities of lower urinary tract, including exstrophy epispadias complex, neurogenic bladder cloaca and posterior urethral valve. The uretero-vesical junction was maintained intact during creation of the MC. Follow-up period ranged from 2-72 months (mean 32.5 months). Satisfactory CIC was possible in 14 children while in two children the stoma became obstructed due to non-usage. Urinary leak via the ureteric MC was seen in only one patient who partially responded to anticholinergic therapy and a shortened CIC interval but this needed to be formally closed subsequently. A refluxing ureter can be used in the creation of a MC without formal reimplantation in the majority of children undergoing BA.

Laparoscopic ureterectomy for the management of painful calculi in a ureteral stump

We present a rare case of a laparoscopic ureterectomy for the treatment of unusual chronic pain from a large retained stone in a ureteral stump. The history of long-term co morbidities from retained ureteral stumps is reviewed, as well as a discussion on the possible etiology of the pain for this particular patient. An argument for the change of the standard of care for the management of ureters in relation to nephrectomies is also made in regard to adult patients with a history of stone disease.

Blind-ending ureteral duplication with calculi

or reflux. 3 Because of non-filling of the blind ureter on intravenous urography (IVU), the diagnosis of blind-ending ureteral duplication is best made with the help of retrograde pyelography. However, a blind-ending bifid ureter can be opacified on IVU if uretero-ureteral reflux is present. The anomaly can also be seen on computerized tomography. 4 We report a case featuring a long, blind-ending ureteral duplication complicated by stone formation. Case Report A 45-year old male was admitted with right loin pain, dysuria and frequency of micturition of 3 months duration. He reported passing stones in urine in the past, but had no history of fever or recurrent urinary tract infection (UTI). The patient had presented to another hospital with the same complaints 6 weeks before reporting to our unit. Cystoscopy at that hospital showed a normal bladder with no calculus in the bladder or the ureters. He came to our unit because of persistent pain. Laboratory investigations showed normal renal function. Urine microscopy and culture showed red blood cells in the urine, but no bacterial growth. Plain radiograph of the kidneys, ureters and bladder (KUB) revealed two radio-opaque shadows in the region of the lower third of the right ureter (Figure 1). However, IVU showed patent ureters with no calculus seen in either ureter (Figure 2). A pre-operative CT scan showed grossly normal kidneys and ureters with 2 extravesical masses in the pelvis. Cystoscopy in our unit revealed an edematous mass just caudal and medial to the right ureteric orifice. A guide wire introduced into the right ureter under fluoroscopic control showed that the radio-opaque shadows seen on KUB were extraureteral and extravesical. Right retrograde pyelography showed a patent ureter with opacification of a normal pelvicalyceal system. Transurethral resection of the bullous, edematous mass revealed another ureteric orifice. Retrograde pyelography through the other ureteric orifice revealed multiple filling defects and a long blind-ending ureter, with no opacification of the pelvi-calyceal system (Figure 3). Ureteroscopy through the second ureteric orifice confirmed the presence of 2 calculi, which were removed using a Dormia basket. Post-operatively the patient became pain free. Postoperative micturating cystourethrogram (MCUG) performed 3 months after calculus extraction from the duplicated ureter, showed no vesicoureteric reflux (VUR).

Retroperitoneoscopic surgery with extracorporeal uretero-ureteral anastomosis for treating retrocaval ureter

We present a case of retrocaval ureter featuring laparoscopic technique treatment using extraperitoneal access and extracorporeal suture of the ureteral stumps. Surgical time was 130 minutes, and the anastomosis was performed in 40 minutes. There were no intra- or postoperative complications, and the patient was discharged from hospital on the second postoperative day. The medium-term outcome featured similar results to pure laparoscopic technique. We conclude that this technical variation for treatment of retrocaval ureter makes the procedure easier and provides a drastic reduction in surgical time, without compromising the minimally invasive aspect of this kind of approach.

Robotically assisted retroperitoneoscopic heminephrectomy in children: initial clinical results

Objective To investigate the feasibility of robotically assisted retroperitoneoscopic upper pole heminephrectomy with the Da Vinci Surgical System™. Patients and methods Fourteen girls (median age 4.9 years, range 0.5–20.2) underwent upper pole heminephrectomy using the retroperitoneal approach with the Da Vinci Surgical System™. Prior to all procedures a ureteric catheter was placed. Using a modified access to the retroperitoneum the ureter to the upper pole and the vessels were dissected and ligated. The upper pole was removed by diathermy or ultrasonic scissors. Results The median operative time was 176 min (range 120–360 min). In two patients, the procedure was converted to an open operation; in one case due to lack of progress, and in the other due to bleeding which could not be handled with the robotically assisted instruments. One patient had the ureteric stump removed due to recurrent infections. In all other patients the peri- and postoperative period was uneventful. Conclusion The robotically assisted system is an excellent tool for minimally invasive surgery in the retroperitoneum, such as pyeloplasty, with its advantages of wrist-like movements of the instruments, magnified three-dimensional view, tremor control and improved ergonomics for the surgeon. Further development of the instruments is required before the resection of a non-functioning upper pole can be included in the spectrum of indications.

Uretero‐ureterocutaneostomy (wrapped by omentum)

The tubularized-incised plate urethroplasty has traditionally been used in children for repairing hypospadias. As shown here, it can also be used successfully in adults, with very good results. The rate of wound healing, infection and complications is the same as in children, as are the cosmetic and functional outcomes. To evaluate the outcome of uretero-ureterocutaneostomy (UUC) wrapped by omentum for palliative cystectomy in symptomatic elderly high-risk patients with high-stage bladder cancer. The study included 15 patients (14 men and one woman, aged 72-87 years, American Society of Anesthesiology score 3) with symptomatic recurrent bleeding bladder cancer (T2/T3) who were treated with palliative cystectomy. UUC was performed by mobilizing the right pre-vesical divided ureter up to the pelvi-ureteric junction and a high retroperitoneal crossover to the divided left ureter. A stoma was created with a circular 2-cm skin excision and resecting the fatty subcutaneous tissue. Wrapped by the omentum, both well-vascularized ureteric stumps were pulled through a cross-like fascia incision up to skin level. Spatulated and everted, the 'butterfly' flaps were fixed to the skin and underlying omentum. Soft splints were inserted for 21 days and a Karaya ring placed. The postoperative course and stoma healing was normal in 14 of the 15 patients; the sigmoid was resected because of sigmoid diverticulitis in one. The median (range) follow-up was 15 (6-24) months. There was pyelonephritis in one patient, and the dilatation of the upper tract (grade 3) in two returned to grade 2, with new asymptomatic grade 1 dilatation in one other. All patients were without stents and stoma care was provided at home. This modified UUC by omental wrapping in 15 high-risk patients after palliative cystectomy was simple and safe, and their recovery was uneventful. To date the few patients with stomal obstruction were managed by J catheters, changed every 4-6 months.

SYMPTOMATIC REFLUXING DISTAL URETERAL STUMPS AFTER NEPHROURETERECTOMY AND HEMINEPHROURETERECTOMY. WHAT SHOULD WE DO?

We hypothesize that residual ureteral stumps following nephroureterectomy (NU) or heminephroureterectomy (HNU) are associated with an increased risk of urinary tract infection (UTI) that is decreased by distal ureterectomy. We performed a retrospective review of 71 patients who underwent NU or HNU for reflux into a nonfunctioning system between 1990 and 2003. The indications for all renal surgery included recurrent UTIs in 44 patients, hypertension in 8 and a combination of these conditions in 19. Voiding cystourethrogram and urine cultures were performed in all patients with recurrent symptomatic UTIs. Followup in all 71 patients averaged 52 months. A total of 11 patients who underwent laparoscopic NU or HNU to the hiatus of the bladder were excluded because they did not have a ureteral remnant. The remaining 60 patients all underwent an open procedure. Of these patients 32 (53%) had refluxing distal ureteral remnants. Six of these 32 patients with refluxing stumps (19%), all girls, became symptomatic during followup. Symptomatic UTIs recurred in these 6 patients an average of 12 times per year (range 8 to 21), which significantly decreased after distal ureterectomy. If surgery is indicated in patients with reflux into a poorly functioning system, we recommend NU or HNU to the level of the bladder hiatus. If a symptomatic ureteral remnant is present, then distal ureterectomy decreases the rate of symptomatic UTIs in these patients. Laparoscopic distal ureterectomy is a viable surgical technique for this patient population.

Spontaneous, unriitting gross hematuria occurring one week after laparoscopic donor nephrectomy

Complications associated with the ureteral stump after nephrectomies rarely occur, especially after donor nephrectomies. The potential for the slippage of clips is a well-known event associated with vascular ligations. We report on the first case of clip slippage from the ureter and describe diagnosis and management of the most extreme of morbid presentations.

Long-Term Follow-Up of Ureteral Stump Tumors after Nephrectomy for Benign Renal Disease

The occurrence of primary carcinoma of the ureteral stump after nephrectomy is rare. In this study, we evaluated the clinical characteristics of ureteral stump tumors after nephrectomy for benign renal disease. During a 16-year period, 318 consecutive patients underwent simple nephrectomy for benign renal disease (216 cases) or for donation (102 cases). Eight of these 318 patients diagnosed as having an ureteral stump tumor were treated by ipsilateral ureterectomy with cuff excision of the bladder. Pathologic findings, tumor stages, and clinical characteristics were analyzed. The eight ureteral stump tumors comprised; 6 transitional cell carcinomas (TCCs) and 2 squamous cell carcinomas (SCCs). The mean interval between nephrectomy and ureteral stump tumor diagnosis was 76.5 months. Six of the 8 patients had pyonephrosis and two renal tuberculosis as original renal diseases. Four of the 6 TCCs were stage T1 and 2 stage T2. There was no concomitant bladder tumor at stump tumor diagnosis. Hematuria was the major presenting symptom in 3 of the 8 patients and 4 patients were diagnosed by follow-up imaging study. Two of the 6 ureteral stump TCC patients developed bladder TCC during follow-up. The 5-year survival rate of patients with ureteral stump tumor was 37.5%. T1G1 TCC was associated with a better survival than T2 or G2 TCC. No ureteral stump tumor occurred in cases of donor nephrectomy. This study demonstrate, that long-term closed observation is needed to detect ureteral stump tumor, particularly in patients that have undergo nephrectomy for a long-standing inflammatory renal disease such as pyonephrosis or tuberculosis. Hematuria is a major presenting symptom of ureteral stump tumor. However, a follow-up imaging study is also important for ureteral stump tumor detection. The prognosis is poor in cases developing ureteral stump SCC, bladder tumor recurrence, or a high-grade ureteral tumor.

Transitional cell carcinoma of ureteral stump after radical nephrectomy in a patient with a history of bladder carcinoma

Transitional cell carcinoma (TCC) of ureteral stump after radical nephrectomy is rare. Following nephrectomy patients with a prior history of bladder cancer must have their ureteral stumps evaluated. Furthermore, the presence of hematuria should alert the urologist to a possible TCC in the ureteral stump. We present a patient who developed TCC of the ureteral stump after radical nephrectomy.

残存尿管に発生した原発性未分化癌の1例

A 72-year-old man referred our hospital with the chief complaint of macroscopic hematuria. He had undergone simple left nephrectomy for left renal stone when he was 27-years-old. His urine cytology showed class IIIb. They were 4 times. We performed random biopsy of the bladder and retrograde pyelography of the right But they were no positive findings for the cause of hematuria and for the existence of malignancy. After 2 months, he had macroscopic hematuria again. Cystoscopic re-examination revealed a fibrin out of the residual left ureteral orifice. Computed tomographic scan showed a perivesical mass. The diagnosis was the carcinoma of the ureteral stump. We performed ureterectomy. The pathological study revealed the undifferentiated carcinoma. This case is the first report of the undifferentiated carcinoma occurred on the residual ureteral stump in the Japanese literature.

Ex Vivo Ureteroscopic Treatment of Calculi in Donor Kidneys at Renal Transplantation

We evaluated the safety and efficacy of ex vivo ureteroscopy (ExURS) as a means of rendering the donated kidney stone-free at live donor renal transplantation. A total of 10 suitable kidney donors with small, unilateral nonobstructive calculi underwent live donor nephrectomy (8 open flank, 2 hand assisted transperitoneal). Immediately after cold perfusion, ExURS was performed in an iced saline solution. Access to the collecting system was via the ureteral stump. Calculi were either removed with endoscopic baskets and/or completely fragmented with Holmium laser lithotripsy. Access to the renal collecting system was technically successful in all cases. A total of 10 stones, ranging in largest diameter from 1 to 8 mm (average 5.2) were visualized. Of the kidneys 6 had solitary stones, 2 had 2 stones and 1 had no stone. Of 10 stones 9 were successfully removed and/or fragmented with an average procedure time of 6.5 minutes (range 3 to 28). Indwelling ureteral stents were placed at transplantation in 5 of 10 kidneys. There were no intra-operative or postoperative ureteral complications. At 1 month after transplant serum creatinine ranged from 0.9 to 2.7 mg/dl (average 1.5). At a mean followup of 33.2 months new stones have not formed in any recipients and at mean 36.4-month followup no new calculi have formed in the remaining kidney of any donors. ExURS is a technically feasible means of rendering a stone bearing kidney stone-free without compromising ureteral integrity or renal allograft function.

A Retained Ureteral Stump With Calculi

Augmentation cystoplasty is a commonly used method to treat patients with inadequate bladder capacity. Calculus formation within the altered urinary tract has been a frequent complication. We report the unique finding of calculi within a retained ureteral stump in a patient who had undergone enterocystoplasty. CASE REPORT A 29-year-old female presented with recurrent urinary tract infections that were refractory to treatment. The patient had been born with sacral agenesis and imperforate anus. Neurogenic bladder and vesicoureteral reflux had subsequently developed, and the patient underwent ileal conduit formation for management of progressive bilateral hydroureteronephrosis as a young child. At age 15 years she underwent urinary undiversion with ileocecoplasty to the native bladder. Videourodynamics were repeated at age 28 years and revealed a volume capacity of 700 ml., and bilateral grade V vesicoureteral reflux and reflux into the retained ureteral stumps. The patient performed clean intermittent catheterization every 2 to 4 hours to minimize the post-void residual urine volume. Recurrent urinary tract infections were managed with outpatient oral antibiotic therapy. In addition, in 1999 a bladder calculus had developed in the bowel segment of the bladder. The stone was managed with cystolithotripsy, with complete stone removal. In 2001 urinary tract infections recurred despite appropriate antibiotic coverage for each recurrent infection and antibiotic prophylaxis. Symptoms consisted of painful urethral catheterizations, small urethral catheterized volumes and pyuria. Plain x-ray of the kidneys, ureters and bladder demonstrated multiple calcified densities in the pelvis (see figure). In preparation for cystolithotripsy, cystoscopy of the native and augmented bladder was performed, which showed an absence of bladder calculi. However, a dilated and patulous right ureteral orifice was identified. Retrograde ureterogram revealed several filling defects in the right ureteral stump that correlated with the calcifications seen on x-ray. The ureteral stump measured approximately 8 cm. The calculi were fragmented via semirigid ureteroscopy with holmium laser lithotripsy and basket stone extraction. The bladder was copiously irrigated. The patient was discharged home on the same day with postoperative instructions to perform bladder irrigation twice daily in addition to clean intermittent catheterization. Stone analysis demonstrated calcium phosphate. DISCUSSION

A psoas abscess complicating an infected ureteral stump: CT diagnosis

A rare case of a secondary psoas abscess, caused by an infected, obstructed ureteral stump, 32 months following nephrectomy, is reported. The findings of both pathological processes were clearly demonstrated by contrast-enhanced computerized tomography, enabled the urologist to choose the therapeutic approach.

Prolapsed ureterocele after upper pole heminephrectomy

Prolapse of a ureterocele through the external meatus is uncommon, and a prolapsed ureterocele occurring after upper pole heminephrectomy is extremely rare. We describe such a case, occurring 2 months after surgery. The ureterocele was excised with the upper pole ureteral stump, and the lower pole ureter was reimplanted with a good outcome.

Fate of the Retained Ureteral Stump After Upper Pole Heminephrectomy in Duplex Kidneys

No AccessJournal of UrologyPEDIATRIC UROLOGY: Classic Article in Pediatric Urology1 Aug 2002Fate of the Retained Ureteral Stump After Upper Pole Heminephrectomy in Duplex Kidneys Diane De Caluwé, Boris Chertin, and Prem Puri Diane De CaluwéDiane De Caluwé More articles by this author , Boris ChertinBoris Chertin More articles by this author , and Prem PuriPrem Puri More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64722-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for nonfunctioning upper pole moieties in duplex kidneys. Materials and Methods: The medical records of 50 patients who underwent 50 upper pole heminephrectomies for a nonfunctioning upper pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. Results: Median patient age at heminephrectomy was 2.5 years (range 3 weeks to 16.5 years) and median followup was 6 years (range 1 to 11). Indications for heminephrectomy in the 50 renal units were obstructive ureterocele in 25 (50%) cases, ectopic ureter in 15 (30%), obstructive megaloureter in 5 (10%) and reflux nephropathy in 5 (10%). A total of 48 (96%) of the corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Residual stump excision was required in 5 (10%) of the 50 units for recurrent urinary tract infection due to vesicoureteral reflux. Conclusions: Our long-term followup suggests that the majority of patients with residual ureteral stumps after upper pole heminephrectomy do not require stump resection. References 1 : Is there a best alternative to treating the obstructed upper pole?. J Urol1996; 156: 744. Link, Google Scholar 2 : A simplified technique of upper pole heminephrectomy for duplex kidney. J Urol2000; 164: 1326. Abstract, Google Scholar 3 : Ectopic ureter with complete ureteric duplication in the female child. J Pediatr Surg1992; 27: 1455. Google Scholar 4 : Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol1984; 132: 1153. Link, Google Scholar 5 : Ureteral duplication, ectopy, and ureteroceles. In: Pediatric Urology. Edited by . Philadelphia: W. B. Saunders Co.2001: 430. chapt. 28. Google Scholar 6 : Management of ectopic ureters: experience with the upper tract approach. J Urol1997; 158: 1245. Link, Google Scholar 7 : Ectopic ureter with complete ureteric duplication: conservative surgical management. J Pediatr Surg1996; 31: 467. Google Scholar 8 : Upper pole heminephrectomy: is complete ureterectomy necessary?. BJU Int2001; 88: 77. Google Scholar 9 : Natural history of refluxing distal ureteral stumps following tract surgery in children with ectopic ureter or ureterocele. Urol Int2001; 67: 142. Google Scholar 10 : Natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy for vesicoureteral reflux. J Urol1998; 160: 1026. Link, Google Scholar 11 : Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment: management by partial nephroureterectomy alone. J Urol1995; 154: 723. Link, Google Scholar From the Children’s Research Centre, Our Lady’s Hospital for Sick Children, Dublin, Ireland© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLee Y, Hah Y, Kim M, Jung H, Lee M, Im Y and Han S (2012) Factors Associated with Complications of the Ureteral Stump After Proximal UreteroureterostomyJournal of Urology, VOL. 188, NO. 5, (1890-1894), Online publication date: 1-Nov-2012.Wallis M, Khoury A, Lorenzo A, Pippi-Salle J, Bägli D and Farhat W (2018) Outcome Analysis of Retroperitoneal Laparoscopic Heminephrectomy in ChildrenJournal of Urology, VOL. 175, NO. 6, (2277-2282), Online publication date: 1-Jun-2006.GUNDETI M, RANSLEY P, DUFFY P, CUCKOW P and WILCOX D (2018) RENAL OUTCOME FOLLOWING HEMINEPHRECTOMY FOR DUPLEX KIDNEYJournal of Urology, VOL. 173, NO. 5, (1743-1744), Online publication date: 1-May-2005.GRAN C, KROPP B, CHENG E and KROPP K (2018) PRIMARY LOWER URINARY TRACT RECONSTRUCTION FOR NONFUNCTIONING RENAL MOIETIES ASSOCIATED WITH OBSTRUCTING URETEROCELESJournal of Urology, VOL. 173, NO. 1, (198-201), Online publication date: 1-Jan-2005.DUBOSQ F, DOUBLET J, TRAXER O, HAAB F and AMARENCO G (2018) Incontinence From Ectopic Ureter: Retroperitoneal Laparoscopic Urovascular Exclusion of Upper PoleJournal of Urology, VOL. 171, NO. 2, (800-801), Online publication date: 1-Feb-2004. Volume 168Issue 2August 2002Page: 679-680 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurinary tract infectionsnephrectomyvesico-ureteral refluxureterMetricsAuthor Information Diane De Caluwé More articles by this author Boris Chertin More articles by this author Prem Puri More articles by this author Expand All Advertisement PDF downloadLoading ...

Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys.

We review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for nonfunctioning upper pole moieties in duplex kidneys. The medical records of 50 patients who underwent 50 upper pole heminephrectomies for a nonfunctioning upper pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. Median patient age at heminephrectomy was 2.5 years (range 3 weeks to 16.5 years) and median followup was 6 years (range 1 to 11). Indications for heminephrectomy in the 50 renal units were obstructive ureterocele in 25 (50%) cases, ectopic ureter in 15 (30%), obstructive megaloureter in 5 (10%) and reflux nephropathy in 5 (10%). A total of 48 (96%) of the corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Residual stump excision was required in 5 (10%) of the 50 units for recurrent urinary tract infection due to vesicoureteral reflux. Our long-term followup suggests that the majority of patients with residual ureteral stumps after upper pole heminephrectomy do not require stump resection.

Long-term outcome of the retained ureteral stump after lower pole heminephrectomy in duplex kidneys.

Duplication of the ureter and renal pelvis is the most common upper urinary tract anomaly in childhood. The anatomical and functional divisions between upper and lower moieties of duplex kidney are extremely variable. The underlying pathological condition associated with a lower moiety is usually massive vesicoureteral reflux (VUR) to the lower collecting system and only rare obstruction. The non-functioning upper moiety is usually associated with obstructive ectopic ureter (with or without ureterocele). Most lower pole heminephrectomies are carried out for non-functioning lower moieties. In most cases, the lower defunctionalised segment of the ureter is left in situ. Complete ureterectomy is usually performed if presence of VUR into the lower end of the corresponding ureter is shown. There is little information on the long-term outcome of residual ureteral 'stumps'. The purpose of our study was to review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for non-functioning lower pole moieties in duplex kidneys. The medical records of 19 patients who underwent 20 lower pole heminephrectomies for a non-functioning lower pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. Median age at heminephrectomy was 4.5 years (range: 1 month to 12 years). Indications for heminephrectomy in the 20 renal units was reflux nephropathy in 16 (80%) and obstructive nephropathy in 4 (20%). All corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Median follow-up was 8.5 years (range: 1-11 years). Eight (40%) showed VUR into the stump after lower pole heminephrectomy. Two of these underwent subureteral endoscopic correction of VUR with polytetrafluoroethylene paste and resection of the stump was carried out in remaining two patients for recurrent urinary tract infections (UTI). Remaining four of the eight patients demonstrated spontaneous resolution of VUR during follow-up. Our data suggest that the vast majority of patients with residual ureteral stumps after lower pole heminephrectomy do not require stump resection at long-term follow-up.

The role of refluxing distal ureteral stumps after nephrectomy

Background/Purpose: Classically, the refluxing distal ureteral stump has been removed during the nephrectomy by the means of an incision on the flank and lower abdominal wall. There are little data in the literature about the natural history of these stumps. In the current work the authors evaluated possible complications affecting the ureteral stump after total or partial nephrectomy for vesicoureteral reflux. Methods: Between June 1974 and May 1991, our institution performed 25 nephrectomies followed by partial ureterectomy to correct vesicoureteral reflux into a nonfunctional kidney. The authors performed, respectively, 16 total and 9 partial nephrectomies. The reflux to operated units was graded according to the International Grading System as grade 1 (n = 1), grade 2 (n = 4), grade 3 (n = 9), grade 4 (n = 8), and grade 5 (n = 1). Results: Ureteral stump removal was performed in 3 patients (13%). No correlation between the need for ureteral stump removal and age, gender, grade of preoperative reflux, associated contralateral reflux, and ureteral histology, became apparent. Conclusion: The remainder of the ureteral stump, after a total or partial nephrectomy to correct vesicoureteral reflux, presents a low rate of complications even in the presence of a high grade of reflux. J Pediatr Surg 37:653-656. Copyright 2002, Elsevier Science (USA). All rights reserved.