Upper pole heminephrectomy: is complete ureterectomy necessary?

Objective To determine the re-operation rate on the distal meter after uppe r pole heminephrectomy with incomplete ureterectomy. Patients and methods The case notes from one institution were reviewed retr ospectively; 60 upper pole heminephrectomies with incomplete ureterectomy w ere undertaken in 39 girls and 16 boys (mean age at primary surgery 27 mont hs, range 3-88). Results Thirty-two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty-nine of the 60 renal units (48%) had an associated ure terocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underw ent initial puncture of a ureterocele. Five patients (8%), all females, req uired lower urinary tract re-operation. The indications for secondary surge ry were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child. Conclusions The re-operation rate for a redundant ureteric stump in this se ries was 8%. The risk of injury to the good ureter may outweigh the benefit s of a complete ureterectomy.