Mid-Term Outcome of Distal Ureteral Stump after (Hemi)Nephroureterectomy

Abstract

Aims: The complete removal of the ureter minimises the risk of future morbidity associated with the distal ureteral stump (DUS), including febrile urinary tract infections (UTIs), lower quadrant pain and haematuria – the so-called ureteral stump syndrome (USS). This research evaluated the mid-term outcome of DUS after (hemi)nephroureterectomy ((H)NU).Methods: Between July 2008 and April 2019, 29 patients, with a mean age of 4.7 years, underwent (H)NU for poorly functioning dysplastic, scarred, atrophic or hydronephrotic kidneys. Twenty-two patients received total NU, and seven patients received HNU. In all patients, with or without vesicoureteral reflux (VUR), the ureteral stump was ligated.Results: Heminephroureterectomy was applied to three patients for upper pole moieties (one with an ectopic ureter and two with ureteroceles) and to four patients for lower pole moieties with high-grade VUR. Total NU procedures were performed for nephrolithiasis, ureteropelvic junction obstruction, xanthogranulomatous pyelonephritis, multicystic dysplastic kidneys (MCDKs) and high-grade VUR. Distal ureteral stump resection was required in two patients for USS during the mean 1.5-year follow-up period. Both patients had undergone total NU operations because of high-grade VUR and poorly functioning, dysplastic, scarred kidneys.Conclusion: In this series, USS was seen in only two patients (28.6%) with high-grade VUR in the total NU group. The authors, therefore, believe that high-grade VUR is more important than ureteral stump length and stump ligation for USS development. Therefore, the residual ureter should not be left during NU, especially in cases with VUR.