A simplified technique of upper pole heminephrectomy for duplex kidney

Purpose: We describe a simplified technique of upper pole heminephrectomy i n cases of duplex kidney. Materials and Methods: The upper pole collecting system is entered and the upper pole is excised. The vascular supply to the upper pole is then easily identified and divided. The upper pole ureter is dissected below the lower pole vessels and distal ureteral dissection is completed. We performed the technique in 11 girls and 3 boys with a mean age of 1.8 years who had poor or nonfunctioning upper moieties of duplicated kidneys. The diagnosis was ectopic ureter in 11 cases and ureterocele with duplication in 3. Results: Mean surgical time was 95 minutes. Blood loss was not clinically s ignificant in any patient and mean hospitalization was 2.7 days. The only p ostoperative complication was atelectasis, which resolved promptly with med ical treatment. There was no injury to the lower pole ureter or vascular pe dicle. Conclusions: Our technique enables reliable and safe excision of upper pole renal tissue with the maximal preservation of functioning lower pole paren chyma. The chance of inadvertent entry into the lower pole collecting syste m is significantly decreased since the demarcation of the upper and lower m oieties is clearly identifiable. In addition, the avoidance of initial, pot entially cumbersome hilar dissection minimizes the risk of injury to the lo wer pole ureter and vascular supply. This technique may be performed rapidl y and requires only brief hospitalization postoperatively.