Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction

Objective To assess the outcome of the distal ureteric stump (DUS) after (h emi)nephrectomy with subtotal ureterectomy. Patients and methods The records of 89 patients (median age 2.7 years, rang e 0.25-12) who underwent nephrectomy (24) or heminephrectomy (65) with subt otal ureterectomy between 1982 and 1996 were reviewed retrospectively for s ymptoms caused by the DUS. The mean follow-up was 9.8 years. Nephrectomy wa s undertaken for a poorly functioning dysplastic (in nine), scarred (in 10) or hydronephrotic (in five) kidney, and heminephrectomy for a poorly funct ioning upper moiety associated with ectopic ureterocele (in 26) or stenotic hydroureter (in 15), or for a poorly functioning lower moiety associated w ith reflux (in 24). There were 38 refluxing and 51 non-refluxing ureteric s tumps. Two additional patients primarily operated elsewhere were referred w ith DUS symptoms. Results Only one patient had a symptomatic DUS, with recurrent haematuria a nd bacteriuria. The two patients referred from elsewhere presented with feb rile UTIs. The first had been left with a long refluxing stump opening ecto pically into the urethra, and the second with a long stump which was conver ted from nonrefluxing to a refluxing stump when he developed dysfunctional voiding, Surgical excision of the distal stump was curative in each case. Conclusions The risk of a symptomatic DUS in patients who undergo subtotal ureterectomy in conjunction with (hemi)nephrectomy is very low, with no dif ference between refluxing and nonrefluxing stumps. Long ureteric stumps and dysfunctional voiding may cause symptoms. Because of the low morbidity ass ociated with a short ureteric stump, we recommend subtotal ureterectomy in children who undergo (hemi)nephrectomy for reflux, vesico-ureteric obstruct ion or ectopic ureterocele associated with a poorly functioning kidney or k idney moiety.