MANAGEMENT OF ECTOPIC URETERS - EXPERIENCE WITH THE UPPER TRACT APPROACH

Purpose: The necessity of removing the ureteral stump after upper trac t surgery for an ectopic ureter has been debated. We reviewed the reco rds of patients initially treated at the kidney level to evaluate indi cations for later stump removal. Materials and Methods: We reviewed th e medical records of 32 patients with 33 ectopic ureters treated at th e kidney level during the last 10 years. Results: Ectopic ureters were associated with duplicated collecting systems in 31 cases and with si ngle systems in 2. Upper pole heminephrectomy and partial ureterectomy were performed in 23 units and upper tract reconstruction was done in 8. Both patients with single systems underwent nephrectomy. Four pati ents (12%) required repeat surgery at the bladder level, including 1 w ho underwent ureteral reimplantation for persistent ipsilateral lower pole reflux and simultaneous upper pole stump removal. Preoperative vo iding cystourethrography revealed reflux into the ectopic ureter in 1 patient with postoperative reflux and infections. The remaining 2 pati ents required a repeat operation to remove the stump due to recurrent urinary tract infections and newly detected reflux into the stump, res pectively. Conclusions: The majority of patients with ectopic ureters can be treated by addressing only the upper urinary tract. No patient who presented with incontinence required ureteral stump removal. Wheth er noted preoperatively or postoperatively, reflux into the ectopic ur eter necessitated ureteral stump removal. Three of the 6 patients (50% ) who had reflux to the ipsilateral kidney required lower tract surger y.