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SYMPTOMATIC REFLUXING DISTAL URETERAL STUMPS AFTER NEPHROURETERECTOMY AND HEMINEPHROURETERECTOMY. WHAT SHOULD WE DO?

2005; Lippincott Williams & Wilkins; Volume: 173; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000147849.80627.41

1527-3792

Pasquale Casale, Richard W. Grady, Richard S. Lee, Byron D. Joyner, Michael E. Mitchell,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyPediatric Urology1 Jan 2005SYMPTOMATIC REFLUXING DISTAL URETERAL STUMPS AFTER NEPHROURETERECTOMY AND HEMINEPHROURETERECTOMY. WHAT SHOULD WE DO? PASQUALE CASALE, RICHARD W. GRADY, RICHARD S. LEE, BYRON D. JOYNER, and MICHAEL E. MITCHELL PASQUALE CASALEPASQUALE CASALE More articles by this author , RICHARD W. GRADYRICHARD W. GRADY Financial interest and/or other relationship with Q-Med and Diagnostic Ultrasound, Inc More articles by this author , RICHARD S. LEERICHARD S. LEE More articles by this author , BYRON D. JOYNERBYRON D. JOYNER More articles by this author , and MICHAEL E. MITCHELLMICHAEL E. MITCHELL More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000147849.80627.41AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We hypothesize that residual ureteral stumps following nephroureterectomy (NU) or heminephroureterectomy (HNU) are associated with an increased risk of urinary tract infection (UTI) that is decreased by distal ureterectomy. Materials and Methods: We performed a retrospective review of 71 patients who underwent NU or HNU for reflux into a nonfunctioning system between 1990 and 2003. The indications for all renal surgery included recurrent UTIs in 44 patients, hypertension in 8 and a combination of these conditions in 19. Voiding cystourethrogram and urine cultures were performed in all patients with recurrent symptomatic UTIs. Results: Followup in all 71 patients averaged 52 months. A total of 11 patients who underwent laparoscopic NU or HNU to the hiatus of the bladder were excluded because they did not have a ureteral remnant. The remaining 60 patients all underwent an open procedure. Of these patients 32 (53%) had refluxing distal ureteral remnants. Six of these 32 patients with refluxing stumps (19%), all girls, became symptomatic during followup. Symptomatic UTIs recurred in these 6 patients an average of 12 times per year (range 8 to 21), which significantly decreased after distal ureterectomy. Conclusions: If surgery is indicated in patients with reflux into a poorly functioning system, we recommend NU or HNU to the level of the bladder hiatus. If a symptomatic ureteral remnant is present, then distal ureterectomy decreases the rate of symptomatic UTIs in these patients. Laparoscopic distal ureterectomy is a viable surgical technique for this patient population. References 1 : Refluxing ureteral stump: reservoir of urinary tract infection. J Urol1964; 91: 493. Abstract, Google Scholar 2 : Refluxing ureteral stump. Scand J Urol Nephrol1978; 12: 181. Google Scholar 3 : Recurrent symptoms of urinary tract infection in eight patients with refluxing ureteric stumps. Br J Urol1994; 74: 720. Google Scholar 4 : Vesicoureteral reflux in complete ureteral duplication: surgical options. J Urol1988; 140: 1092. Link, Google Scholar 5 : Natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy for vesicoureteral reflux. J Urol1998; 160: 1026. Link, Google Scholar 6 : A new technique of exclusion of the remaining, refluxing ureteral stump in cases of ectopic ureteral implantation. J Urol (Paris)1988; 94: 329. Google Scholar 7 : Endoscopic Teflon injection for a refluxing ureteric stump after simple nephrectomy. Br Med J1985; 290: 1109. Google Scholar 8 : Endoscopic treatment of refluxing ureteric stump following nephrectomy with Tissucol and teflon injections. Eur Urol1989; 16: 312. Google Scholar From the Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania (PC), and Seattle Children's Hospital, University of Washington, Seattle, Washington© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 173Issue 1January 2005Page: 204-206 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsureterkidneyvesico-ureteral refluxMetricsAuthor Information PASQUALE CASALE More articles by this author RICHARD W. GRADY Financial interest and/or other relationship with Q-Med and Diagnostic Ultrasound, Inc More articles by this author RICHARD S. LEE More articles by this author BYRON D. JOYNER More articles by this author MICHAEL E. MITCHELL More articles by this author Expand All Advertisement PDF downloadLoading ...