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Upper pole heminephrectomy: is complete ureterectomy necessary?
Author(s) -
AdeAjayi N.,
Wilcox D.T.,
Duffy P.G.,
Ransley P.G.
Publication year - 2001
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2001.02249.x
Subject(s) - ureterocele , medicine , ureter , ectopic ureter , upper urinary tract , urinary system , surgery , megaureter , urology
Objective To determine the re‐operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy. Patients and methods The case notes from one institution were reviewed retrospectively; 60 upper pole heminephrectomies with incomplete ureterectomy were undertaken in 39 girls and 16 boys (mean age at primary surgery 27 months, range 3–88). Results Thirty‐two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty‐nine of the 60 renal units (48%) had an associated ureterocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underwent initial puncture of a ureterocele. Five patients (8%), all females, required lower urinary tract re‐operation. The indications for secondary surgery were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child. Conclusions The re‐operation rate for a redundant ureteric stump in this series was 8%. The risk of injury to the good ureter may outweigh the benefits of a complete ureterectomy.