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.

Keywords

• ureteral stump syndrome
• distal ureteral stump
• heminephrectomy
• children

Ethical Statement

The study was approved by Ankara Bilkent City Hospital Clinical Research Ethics Committee (Approval No: TABED 1-24-836, Date: 18 December 2024). All procedures were performed in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki.

(Hemi)Nefroüreterektomi Sonrası Distal Üreter Güdüğünün Orta Vadeli Sonuçları

Abstract

Amaç: Üreterin tamamen çıkarılması, distal üreter güdüğü (DÜG) ile ilişkili gelecekteki morbidite riskini; febril üriner sistem enfeksiyonları (ÜSE), alt kadran ağrısı ve hematüriyi içeren ve üreter güdüğü sendromu (ÜGS) olarak adlandırılan tabloyu en aza indirir. Bu çalışmada, yazarların gerçekleştirilen (hemi)nefroüreterektomi [(H)NÜ] sonrası DÜG’nin orta dönem sonuçları değerlendirildi.

Metod: Temmuz 2008 ile Nisan 2019 tarihleri arasında, ortalama yaşı 4,7 yıl olan 29 hastaya kötü fonksiyon gösteren displastik, skarlı, atrofik veya hidronefrotik böbrek nedeniyle (H)NÜ uygulandı. Yirmi iki hastaya total NÜ, yedi hastaya ise HNÜ uygulandı. Vezikoüreteral reflü (VUR) varlığına bakılmaksızın tüm hastalarda üreter güdüğü bağlandı. 

Bulgular: Heminefroüreterektomi; üç hastada üst pol sistemine (bir ektopik üreter ve iki üreterosel) ve dört hastada yüksek dereceli VUR bulunan alt pol sistemine uygulandı. Total NÜ işlemleri; nefrolitiazis, üreteropelvik bileşke darlığı, ksantogranülomatöz piyelonefrit, multikistik displastik böbrekler (MKDB) ve yüksek dereceli VUR nedeniyle gerçekleştirildi. Ortalama 1,5 yıllık takip süresi boyunca iki hastada ÜGS nedeniyle distal üreter güdüğü rezeksiyonu gerekti. Bu iki hastanın da yüksek dereceli VUR ve kötü fonksiyon gösteren displastik, skarlı böbrek nedeniyle total NÜ operasyonu geçirdiği görüldü. 

Sonuç: Bu seride ÜGS yalnızca total NU grubunda yer alan ve yüksek dereceli VUR bulunan iki hastada (%28,6) gözlendi. Bu nedenle yazarlar, ÜGS gelişiminde yüksek dereceli VUR’un, üreter güdüğü uzunluğu ve güdük ligasyonundan daha önemli olduğunu düşünmektedir. Bu nedenle özellikle VUR bulunan olgularda NÜ sırasında rezidüel üreter bırakılmamalıdır.

Keywords

• üreter güdüğü sendromu
• distal üreteral güdük
• (hemi)nefroüreterektomi, çocuk

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