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Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys
Diane De Caluwe1, Boris Chertin, Prem Puri
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Most children with retained ureteral stumps after upper pole heminectomy for duplex kidneys do not need further surgery. Long-term outcomes show residual ureteral stumps are generally safe.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Duplex kidneys are a common congenital anomaly.
- Upper pole heminephrectomy is performed for nonfunctioning moieties.
- Retained ureteral stumps are a potential complication.
Purpose of the Study:
- To evaluate the long-term outcomes of retained ureteral stumps in children.
- To determine the necessity of stump resection after upper pole heminephrectomy.
Main Methods:
- Retrospective review of 50 pediatric patients undergoing upper pole heminephrectomy.
- Data collected from January 1990 to December 2000.
- Analysis of indications, follow-up duration, and complications.
Main Results:
- Indications included ureterocele (50%), ectopic ureter (30%), and others.
- 96% of ureters were managed by transfixation.
- Stump excision was needed in 10% for recurrent urinary tract infections due to vesicoureteral reflux.
Conclusions:
- Long-term follow-up indicates that most residual ureteral stumps are asymptomatic.
- Further resection of ureteral stumps is not typically required.
- Conservative management is often sufficient for retained ureteral stumps.
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.