Complications due to residual ureteral stump after upper pole heminephrectomy: A case report

Surgical resection by heminephrectomy is considered the preferred treatment for duplex kidneys with non-functioning moieties. Ureteral remnant may be ligated or left in situ to avoid the risk of injury to the healthy ipsilateral ureter; however, distal redundant ureter may sometimes cause long-term complications and require further reoperation. Upper pole heminephrectomy is a surgical procedure often performed to address various renal pathologies, such as duplex kidney or non-functioning upper renal moieties. Despite its effectiveness, this surgery can result in postoperative complications, particularly those related to the residual ureteral stump.

We present a case report of a 3-year-old male child with hydronephrosis and recurrent urinary tract infection after a right heminephrectomy for duplicated collecting system one year prior. The child was diagnosed with right hydronephrosis and right hydroureter with right ureteral remnant post-upper-pole right heminephrectomy for duplicated collecting system and left hydronephrosis and left hydroureter due to suspected partial obstruction of left ureterovesical junction. The child then underwent a cystoscopy. Ureteral catheter and Double J (DJ) stent were inserted into the left and right ureter under contrast guidance, and the remnant right ureteral stump was excised.

Recent studies indicate that while most residual ureteral stumps do not cause issues, a significant minority may lead to complications such as recurrent infections and hydronephrosis. Excision of the distal ureteral stump risks damaging the bladder neck and sphincter; hence it is common practice to ligate and leave them in situ. In certain cases, however, the residual ureteral stump may pose a long-term risk of recurrent infection and thus justify extensive excision of the distal ureter during nephrectomy.

It is best not to leave too much part of the ureter to prevent any future complications. If surgical excision of the ureteral remnant after nephrectomy is indicated, distal ureterectomy is the treatment of choice.