Recurrent symptoms of urinary tract infection in eight patients with refluxing ureteric stumps

Persad, R.; Kamineni, S.; Mouriquand, Pierre

doi:10.1111/j.1464-410x.1994.tb07113.x

Cited by 32 publications

(29 citation statements)

References 2 publications

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“…They concluded that the refluxing ureteral stump had a low morbidity. On the other hand, Persad et al [2] stated negative results. They reported the follow-up results of 8 patients with refluxing ureteric stumps, who presented with recurrent urinary tract infections.…”

Section: Discussionmentioning

confidence: 89%

“…On this point, controversies arise regarding further management of the distal refluxing ureteral remnant. There have been advocates [2,8,9] for complete removal of ureteral remnant. Recently, two subsets of studies on management of the persistent ureteral stumps following nephrectomy for a vesicoureteral reflux have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it may compromise the continence mechanisms due to a bladder neck injury during dissection of the ectopic ureter. Unless the ureteral stump is removed, there are also potential risks of infection due to inadequate drainage [1,2]. Therefore, some have advocated that the lower ureteral stump should be removed.…”

Section: Introductionmentioning

confidence: 99%

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Natural History of Refluxing Distal Ureteral Stumps following Upper Tract Surgery in Children with Ectopic Ureter or Ureterocele

Kim¹,

Kim²,

Oh³

2001

Urol Int

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Background: It is a difficult problem to manage refluxing distal ureteral stumps after an upper tract approach in the ectopic ureter and ureterocele. We evaluated the natural history of the remaining refluxing distal ureteral stumps through a close follow-up. Patients and Methods: From 1991 to 1998, nine patients with the ectopic ureter or ureterocele, whose age ranged from one to 20 (median 5.0) months, had undergone an upper tract surgery for ectopic ureter (2) or ectopic ureterocele (7). The upper tract surgery for ureterocele or ectopic ureter included a total nephrectomy (2), a partial nephrectomy (6) or a proximal ureteroureterostomy (1), leaving distal ureteral stump. We evaluated the clinical results of the remaining ureteral stumps every 6 or 12 months. The postoperative follow-up period was 51 (median; range 21–96) months. Results: Among the 9 patients, 5 showed disappearance of the reflux and a markedly reduced stump size in the follow-up study. Improvement was noted in 4 patients within 6 months and in 1 by 20 months postoperatively. Two patients subsequently underwent a bladder level surgery due to problems not associated with the ureteral stump itself. Two patients have been followed up for 30 and 39 months, but without any improvement. An intermittent asymptomatic bacteriuria was noted in all patients during the follow-up, but no patient suffered from symptomatic urinary tract infection requiring an additional surgery. Conclusions: Since refluxing distal ureteral stumps were spontaneously resolved in more than half of the cases and did not cause significant problems during the follow-up, it is not necessary to remove the refluxing ureter simultaneously at the time of the upper tract surgery.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Natural History of Refluxing Distal Ureteral Stumps following Upper Tract Surgery in Children with Ectopic Ureter or Ureterocele

Kim¹,

Kim²,

Oh³

2001

Urol Int

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“…Belman et al 16 proposed that EUS should be ligated if UR is diagnosed in an ectopic ureter before surgery. Persad et al 17 A complete excision of EUS could be necessary only in case of sCUD with concomitant ureteral cancer. To date, only one case of ureteral cancer associated to CUD has been described in an adult patient.…”

Section: Discussionmentioning

confidence: 99%

Single-Setting Laparoscopic Treatment of Complete Bilateral Ureteral Duplication in Adult Women

Anceschi

Torcia²,

Lauretti³

et al. 2011

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Many technique are described to perform nephrouretectomy from open approach to laparoscopic or retroperitoneoscopic surgery. Therefore one of the measures of nephroureterectomy is the complete removal of ureter at its base to reduce risk of a distal ureteral stump and urinary infections (1). Because of this Literature recommends dual approach with complete excision of the kidney and ureter (2).…”

Section: Discussionmentioning

confidence: 99%

Distal Ureteral Stump: Case Report

et al. 2012

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Classically the management of vesico-ureteral reflux associated to poorly functioning kidney is nephrectomy and total removal of ureter. However total removal of ureter is not always possible, especially if it is ectopic. For this reason a distal ureteral stump (DUS) may remain. Literature reports minimal late complications in DUS but when pathologic findings occur it is necessary a patient's surveillance and appropriate therapeutic strategy. Generally the diagnosis of DUS is clinical for presence of infections, stones, tumors and obstruction with or without concomitant infections. In others patients it is described the "Stump Ureteral Syndrome" characterized by recurrent urinary infection, abdominal pain and haematuria. Radiologic support is necessary to confirm the diagnosis and a simple mintional retrograde cystouretrography can see the stump and its morphology if refluxing. We present an assessment of patient with DUS post total nephrectomy and our diagnostic and surgiacal approach. CASE REPORTM.S, a male born at term by natural childbirth after a normal pregnancy. Fetal ultrasound didn't show abdominal malformations. After the birth the baby presented many episodes characterized by fever, abdominal pain and urine culture showed the presence of many colonies of Escherichia Coli. Also the patient showed important growth retardation. For this reason when he was three months of live abdominal ultrasound was performed and it revealed a right renal hypoplasia (diameter 2,5 cm) and reduction of renal medulla while the left kidney (diameter 6,5 cm) was normal. Scintigraphy with DMSA confirmed the right renal hypoplasia and we performed a voiding micturating cystourethrography that showed a right grade 4 vesico-ureteral reflux. When he was old 7 months of life right retroperitoneoscopic nephrectomy was performed with removal of ureter by an additional incision on the flank. The histological examination confirmed the renal hypoplasia and dysplasia with disorganization of muscle fibers of pieloureteral junction and ureter. The patient was discharged in seventh day and there weren't complications like fever, obstruction or UTI. However the patient presented recurrent urinary infections after 4 years from the surgery and antibiotic therapy was prescribed to the baby. We performed voiding micturating cystourethrography that it showed the presence of urinary reflux in the right distal ureteral stump also after total bladder empty ( Fig.1 a-b). Because the parents did not accept to continue antibiotic therapy surgical removal of stump was necessary. Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected t...

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Recurrent symptoms of urinary tract infection in eight patients with refluxing ureteric stumps

Cited by 32 publications

References 2 publications

Natural History of Refluxing Distal Ureteral Stumps following Upper Tract Surgery in Children with Ectopic Ureter or Ureterocele

Natural History of Refluxing Distal Ureteral Stumps following Upper Tract Surgery in Children with Ectopic Ureter or Ureterocele

Single-Setting Laparoscopic Treatment of Complete Bilateral Ureteral Duplication in Adult Women

Distal Ureteral Stump: Case Report

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