Upper pole heminephrectomy: is complete ureterectomy necessary?
OBJECTIVE
To determine the re-operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy.


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.
Ade-Ajayi
N
N
Department of Urology, The Great Ormond Street Hospital for Children, London, UK.
Wilcox
D T
DT
Duffy
P G
PG
Ransley
P G
PG
D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D014513:Ureter / Q000002:abnormalities / Q000601:surgery*; D014515:Ureteral Diseases / Q000473:pathology / Q000601:surgery*