Purpose: We assessed the role and long-term outcome of lower pole hemi
nephrectomy in the treatment of nonfunctioning lower renal moieties in
children with duplex kidneys. Materials and Methods: Between 1979 and
1994, 54 lower pole heminephrectomies were performed in 53 patients 1
to 192 months old (mean age 54) with duplex systems. A total of 15 pa
tients was prenatally diagnosed, while the others presented with a uri
nary tract infection (36), orchiepididymitis (1) and failure to thrive
(1). The surgical technique was essentially similar to that of upper
pole heminephrectomy. Results: Operative course was uneventful except
for intraoperative bleeding in 5 cases, which necessitated blood trans
fusion, and a postoperative urinary tract infection in 1. Followup ran
ged from 3 to 168 months (mean 56.9), Postoperative renograms availabl
e in 34 cases showed unchanged differential function in 12 and an ipsi
lateral 2 to 14% decrease (mean 5.65%) in 22. No late complications we
re detected except in 1 patient, who had postoperative urinary tract i
nfections and subsequently underwent removal of the ureteral stump. Ou
r series includes 4 patients with solitary ipsilateral upper poles (af
ter the contralateral kidney was removed or nonfunctioning) who had go
od renal function at long-term followup despite the reduced parenchyma
l mass. Conclusions: Based on our experience it seems that lower pole
heminephrectomy is the treatment of choice in cases of nonfunctioning
dilated lower segments of duplicated kidneys.