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DISTAL URETERAL STUMP: CASE REPORT

A.L Bulotta, F. Ferrara, M. Sica, G. Di Maggio, M. Messina
  • A.L Bulotta
    Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University Of Siena, Italy
  • F. Ferrara
    Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University Of Siena, Italy
  • M. Sica
    Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University Of Siena, Italy
  • G. Di Maggio
    Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University Of Siena, Italy
  • M. Messina
    Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University Of Siena, Italy | messinam@unisi.it

Abstract

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 to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren’t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

Keywords

nephroureterectomy, distal ureteral stump, vesico-ureteral reflux, stumpectomy.

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Submitted: 2012-08-20 18:11:42
Published: 2012-08-20 18:16:49
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Copyright (c) 2012 A.L Bulotta, F. Ferrara, M. Sica, G. Di Maggio, M. Messina

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