Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters

Abstract

Application of magnetic resonance imaging and minimally invasive techniques have led to changes in the diagnosis and treatment of ectopic upper pole ureters. Recent studies have highlighted the safety of laparoscopic and robot-assisted upper pole heminephrectomy and ureteroureterostomy. Minimally invasive approaches to ectopic upper pole ureters appear safe and effective, with complication rates remaining low. Minimally invasive upper pole heminephrectomy carries a higher risk of lower pole function loss. Both upper pole heminephrectomy and ureteroureterostomy carry a small risk of additional surgery on the bladder and remnant ureter.

Minimal invasive surgery of the distal ureter: indications, advantages and technical considerations from a single-center preliminary experience

“…The significant degree of renal dysplasia in the pathological upper moieties can cause hypertension, proteinuria and malignancies. In different series on UPN specimens, dysplasia was found in 40-70% of cases [30,31] but, despite these concerns, there is still poor evidence of dysplasia-related complications [32]; Levy reported a similar incidence of hypertension comparing patients with UPN and patients with lower urinary reconstruction (9% and 8%, respectively), after a 15-year follow-up [33]. New onset VUR (yo-yo reflux) can occur due to the Y-shaped configuration of the ureteroureteral anastomosis; however, this is theoretical and not confirmed on reported series.…”

“…Valuating the last series on robotic UU the complication rate was 7.8%: no VUR were described, neither additional surgeries on the ureteral stump were required. Robotic UU was compared with open UU showing no differences in mean operative times or complication rates [31]. Infections on the ureteral stump require surgery in 5-14% of UPN and 5-12% of open UU for ectopic ureters [31].…”

“…Robotic UU was compared with open UU showing no differences in mean operative times or complication rates [31]. Infections on the ureteral stump require surgery in 5-14% of UPN and 5-12% of open UU for ectopic ureters [31]. However, laparoscopic and robotic UU series reported no cases of subsequent ureteral stump excision; this could be due to the possibility of a more extensive excision of the ureter down in the pelvis in minimal invasive procedures.…”

A novel method of transvesicoscopic ureteral reimplantation of an ectopic ureter with a mate ureter in a duplex kidney

“…The ectopic ureter usually originates from the upper pole moiety of the duplex kidney. Upper pole nephrectomy is the traditional surgical treatment for the ectopic ureter with poorly functional upper pole moiety in the duplex kidney; however, we recommend UR or ureteroureterostomy when the function of the upper pole is not substantially impaired 5,6 . Dismembered extravesical UR for ectopic upper pole ureters might be a feasible treatment option for patients in whom preserved function of the ectopic moiety necessitates reconstructive surgery instead of excision 6 …”

Gartner-Gang-Zyste – eine altersunabhängige Differenzialdiagnose

“…So wurden, neben konservativen Therapieansätzen bei asymptomatischen Zysten [6], operative Therapieansätze wie Marsupialisation [17] oder Exzision der kompletten Zyste [18], aber auch Ureterektomie bei ektopem Ureterverlauf im Rahmen einer GGZ [1,2] beschrieben. Im Falle einer Doppelniere mit ektop mündendem Harnleiter in der GGZ stellt die Ureteroureterostomie heute eine elegante und gering invasive Alternative zu der früher routinemäßig durchgeführten oberen Heminephrektomie dar [19].…”