Two case reports and review of the literature on ureteric stump syndrome (USS) following hemi-nephrectomy for duplex kidney in adult patients

Abstract

Objective: To report two complications and review the literature on management of ureteric stump syndrome (USS) after upper pole hemi-nephrectomy and subtotal ureterectomy for non-functioning upper moiety of duplex kidney. Patients & Methods: This is a retrospective review of two cases of upper pole hemi-nephrectomy for duplex kidney and the management of subsequent ureteric stump syndrome. Results: Subtotal ureterectomies were performed and the ureteric stumps were left open during upper moiety hemi-nephrectomies in both patients. Both of them developed ureteric stump syndrome with urosepsis and infected dilated remnant ureters, requiring antibiotics and drainage. Secondary operation with ureteroscopy and clearance of stone in the remnant ureter was also performed in one patient. Conclusion: Ureteric stump should be left open intraoperatively to avoid retention in the stump and shorter ureteric stump could avoid ureteric stump syndrome. However, distal ureters in a duplex system share a common sheath and vasculature, dissection of one of the ureters may lead to ischemic injury of the other. Management of USS remained controversial.