Skip to main content

Advertisement

SpringerLink
Log in

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

  • Pediatric Urology (D Weiss, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Ureteral duplication and ectopic upper pole ureters are commonly associated with renal pathology, including vesicoureteral reflux, obstruction, infection, and renal function loss. There remains no consensus on the most appropriate management of these complex patients. In this review, we sought to compare existing data on upper pole heminephrectomy with ipsilateral ureteroureterostomy.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gearhart JG, Rink RC, Mouriquand PDE. Pediatric urology. Philadelphia: Elsevier Health Sciences; 2009.

    Google Scholar 

  2. Siomou E, Papadopoulou F, Kollios KD, Photopoulos A, Evagelidou E, Androulakakis P, et al. Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children. J Urol. 2006;175:678-681-682.

  3. Nation EF. Duplication of the kidney and ureter: a statistical study of 230 new cases. J Urol. 1944;51:456.

    Google Scholar 

  4. Fehrenbaker LG, Kelalis PP, Stickler GB. Vesicoureteral reflux and ureteral duplication in children. J Urol. 1972;107:862–4.

    CAS  PubMed  Google Scholar 

  5. Ambrose SS, Nicolson WP. Ureteral reflux in duplicated ureters. J Urol. 1964;92:439–44.

    CAS  PubMed  Google Scholar 

  6. Campbell MF. Anomalies of the ureter. In: Campbell MF, Harrison JH, editors. Urology. 3rd ed. Philadelphia: WB Saunders; 1970. p. 1487–670.

    Google Scholar 

  7. Uson AC, Lattimer JK, Melicow MM. Ureteroceles in infants and children: a report based on 44 cases. Pediatrics. 1961;27:971–83.

    CAS  PubMed  Google Scholar 

  8. Mandell J, Colodny AH, Lebowitz R, Bauer SB, Retik AB. Ureteroceles in infants and children. J Urol. 1980;123:921–6.

    CAS  PubMed  Google Scholar 

  9. Brock WA, Kaplan GW. Ectopic ureteroceles in children. J Urol. 1978;119:800–3.

    CAS  PubMed  Google Scholar 

  10. Leong J, Mikhael B, Schillinger JF. Refluxing ureteroceles. J Urol. 1980;124:136–9.

    CAS  PubMed  Google Scholar 

  11. Johnston JH, Johnson LM. Experiences with ectopic ureteroceles. Br J Urol. 1969;41:61–70.

    Article  CAS  PubMed  Google Scholar 

  12. Caldamone AA, Snyder HM, Duckett JW. Ureteroceles in children: followup of management with upper tract approach. J Urol. 1984;131:1130–2.

    CAS  PubMed  Google Scholar 

  13. Hagg MJ, Mourachov PV, Snyder HM, Canning DA, Kennedy WA, Zderic SA, et al. The modern endoscopic approach to ureterocele. J Urol. 2000;163:940–3.

    Article  CAS  PubMed  Google Scholar 

  14. Sumfest JM, Burns MW, Mitchell ME. Pseudoureterocele: potential for misdiagnosis of an ectopic ureter as a ureterocele. Br J Urol. 1995;75:401–5.

    Article  CAS  PubMed  Google Scholar 

  15. Bisset GS, Strife JL. The duplex collecting system in girls with urinary tract infection: prevalence and significance. AJR Am J Roentgenol. 1987;148:497–500.

    Article  PubMed  Google Scholar 

  16. Wang M-H. Persistent urinary incontinence: a case series of missed ectopic ureters. Urol Case Rep. 2015;3:223–5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Klauber GT, Crawford DB. Prolapse of ectopic ureterocele and bladder trigone. Urology. 1980;15:164–6.

    Article  CAS  PubMed  Google Scholar 

  18. Diard F, Eklöf O, Lebowitz R, Maurseth K. Urethral obstruction in boys caused by prolapse of simple ureterocele. Pediatr Radiol. 1981;11:139–42.

    Article  CAS  PubMed  Google Scholar 

  19. • Figueroa VH, Chavhan GB, Oudjhane K, Farhat W. Utility of MR urography in children suspected of having ectopic ureter. Pediatr Radiol. 2014;44:956–62. This manuscript documents the utility of MRU in diagnosing ectopic duplex urters, with a positive predictive value (PPV) of 75–88%.

  20. Arevalo MK, Prieto JC, Cost N, Nuss G, Brown BJ, Baker LA. Utility of retrograde ureterocelogram in management of complex ureterocele. J Pediatr Urol. 2016.

  21. Bolduc S, Upadhyay J, Sherman C, Farhat W, Bagli DJ, McLorie GA, et al. Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. J Urol. 2002;168:1123–6.

    Article  PubMed  Google Scholar 

  22. Perrin EV, Persky L, Tucker A, Chrenka B. Renal duplication and dysplasia. Urology. 1974;4:660–4.

    Article  CAS  PubMed  Google Scholar 

  23. Abel C, Lendon M, Gough DC. Histology of the upper pole in complete urinary duplication—does it affect surgical management? Br J Urol. 1997;80:663–5.

    Article  CAS  PubMed  Google Scholar 

  24. Peterson LJ, Grimes JH, Weinerth JL, Glenn JF. Blind-ending branches of bifid ureters. Urology. 1975;5:191–5.

    Article  CAS  PubMed  Google Scholar 

  25. Marshall FF, McLoughlin MG. Long blind-ending ureteral duplications. J Urol. 1978;120:626–8.

    CAS  PubMed  Google Scholar 

  26. Vereecken RL, Proesmans W. Extensive surgery on the trigone for complete ureteral duplication does not cause incontinence or voiding problems. Urology. 2000;55:267-270-271.

  27. Gran CD, Kropp BP, Cheng EY, Kropp KA. Primary lower urinary tract reconstruction for nonfunctioning renal moieties associated with obstructing ureteroceles. J Urol. 2005;173:198–201.

    Article  PubMed  Google Scholar 

  28. Lee YS, Im YJ, Shin SH, Bascuna RT, Ha JY, Han SW. Complications after common sheath reimplantation in pediatric patients with complicated duplex system. Urology. 2015;85:457–62.

    Article  PubMed  Google Scholar 

  29. Afshar K, Papanikolaou F, Malek R, Bagli D, Pippi-Salle JL, Khoury A. Vesicoureteral reflux and complete ureteral duplication. Conservative or surgical management? J Urol. 2005;173:1725–7.

    Article  PubMed  Google Scholar 

  30. Han MY, Gibbons MD, Belman AB, Pohl HG, Majd M, Rushton HG. Indications for nonoperative management of ureteroceles. J Urol. 2005;174:1652-1655-1656.

  31. Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol. 2006;175:716–22.

    Article  PubMed  Google Scholar 

  32. Adorisio O, Elia A, Landi L, Taverna M, Malvasio V, Danti AD. Effectiveness of primary endoscopic incision in treatment of ectopic ureterocele associated with duplex system. Urology. 2011;77:191–4.

    Article  PubMed  Google Scholar 

  33. Wang M-H, Greenfield SP, Williot P, Rutkowski J. Ectopic ureteroceles in duplex systems: long-term follow up and “treatment-free” status. J Pediatr Urol. 2008;4:183–7.

    Article  PubMed  Google Scholar 

  34. Cooper CS, Passerini-Glazel G, Hutcheson JC, Iafrate M, Camuffo C, Milani C, et al. Long-term followup of endoscopic incision of ureteroceles: intravesical versus extravesical. J Urol. 2000;164:1097-1099-1100.

  35. Jayanthi VR, Koff SA. Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems. J Urol. 1999;162:1077–80.

    Article  CAS  PubMed  Google Scholar 

  36. Byun E, Merguerian PA. A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol. 2006;176:1871–7. discussion 1877.

    Article  PubMed  Google Scholar 

  37. Lee RS, Sethi AS, Passerotti CC, Retik AB, Borer JG, Nguyen HT, et al. Robot assisted laparoscopic partial nephrectomy: a viable and safe option in children. J Urol. 2009;181:823-828-829.

  38. Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol. 2012;26:602–13.

    Article  PubMed  Google Scholar 

  39. • Mason MD, Anthony Herndon CD, Smith-Harrison LI, Peters CA, Corbett ST. Robotic-assisted partial nephrectomy in duplicated collecting systems in the pediatric population: techniques and outcomes. J Pediatr Urol. 2014;10:374–9. This manuscript addresses technical concerns regarding RALUU and demonstrates a low complication rate among 21 patients with duplex collecting systems.

  40. Bansal D, Cost NG, Bean CM, Noh PH. Pediatric laparo-endoscopic single site partial nephrectomy: feasibility in infants and small children for upper urinary tract duplication anomalies. J Pediatr Urol. 2014;10:859–63.

    Article  CAS  PubMed  Google Scholar 

  41. Herz D, DaJusta D, Ching C, McLeod D. Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: a descriptive series. J Pediatr Urol. 2016;12:266.e1–6.

    Article  CAS  Google Scholar 

  42. • Malik RD, Pariser JJ, Gundeti MS. Outcomes in pediatric robot-assisted laparoscopic heminephrectomy compared with contemporary open and laparoscopic series. J Endourol. 2015;29:1346–52. This paper reports outcomes in patients with duplex collecting systems treated with RALHN., with mean renal function loss of 2.6% in 7 patients, and 1 patient (14%) with renal loss over 10% in addition to 2 reoperations (12.5%) for removal of a ureteral remnant.

  43. Olsen LH, Jørgensen TM. Robotically assisted retroperitoneoscopic heminephrectomy in children: initial clinical results. J Pediatr Urol. 2005;1:101–4.

    Article  CAS  PubMed  Google Scholar 

  44. Cabezali D, Maruszewski P, López F, Aransay A, Gomez A. Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol. 2013;27:133–8.

    Article  PubMed  Google Scholar 

  45. Lee YS, Hah YS, Kim M-J, Jung HJ, Lee M-J, Im YJ, et al. Factors associated with complications of the ureteral stump after proximal ureteroureterostomy. J Urol. 2012;188:1890–4.

    Article  PubMed  Google Scholar 

  46. Piaggio L, Franc-Guimond J, Figueroa TE, Barthold JS, González R. Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children. J Urol. 2006;175:2269–73.

    Article  PubMed  Google Scholar 

  47. You D, Bang JK, Shim M, Ryu DS, Kim KS. Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys. BJU Int. 2010;106:250–4.

    Article  PubMed  Google Scholar 

  48. Husmann DA, Ewalt DH, Glenski WJ, Bernier PA. Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment: management by partial nephroureterectomy alone. J Urol. 1995;154:723–6.

    Article  CAS  PubMed  Google Scholar 

  49. Jayram G, Roberts J, Hernandez A, Heloury Y, Manoharan S, Godbole P, et al. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: a multicenter review. J Pediatr Urol. 2011;7:272–5.

    Article  CAS  PubMed  Google Scholar 

  50. Plaire JC, Pope JC, Kropp BP, Adams MC, Keating MA, Rink RC, et al. Management of ectopic ureters: experience with the upper tract approach. J Urol. 1997;158:1245–7.

    Article  CAS  PubMed  Google Scholar 

  51. De Caluwe D, Chertin B, Puri P. Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys. J Urol. 2002;168:679–80.

    Article  PubMed  Google Scholar 

  52. Gundeti MS, Ransley PG, Duffy PG, Cuckow PM, Wilcox DT. Renal outcome following heminephrectomy for duplex kidney. J Urol. 2005;173:1743–4.

    Article  CAS  PubMed  Google Scholar 

  53. • Joyeux L, Lacreuse I, Schneider A, Moog R, Borgnon J, Lopez M, et al. Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study. Surg Endosc. 2016. This manuscript reports renal outcomes following laparoscopic retroperitoneal heminephrectomy with a mean of 7 years follow-up. They demonstrate renal function loss in four patients (17%), with losses ranging from 6 to 18%.

  54. Vates TS, Bukowski T, Triest J, Freedman A, Smith C, Perlmutter A, et al. Is there a best alternative to treating the obstructed upper pole? J Urol. 1996;156:744–6.

    Article  CAS  PubMed  Google Scholar 

  55. Casale P, Lambert S. Robotic ureteroureterostomy in children with a duplex collecting system. J Robot Surg. 2009;3:161.

    Article  PubMed  Google Scholar 

  56. Storm DW, Modi A, Jayanthi VR. Laparoscopic ipsilateral ureteroureterostomy in the management of ureteral ectopia in infants and children. J Pediatr Urol. 2011;7:529–33.

    Article  PubMed  Google Scholar 

  57. Grimsby GM, Merchant Z, Jacobs MA, Gargollo PC. Laparoscopic-assisted ureteroureterostomy for duplication anomalies in children. J Endourol. 2014;28:1173–7.

    Article  PubMed  Google Scholar 

  58. Wiygul J, Palmer LS. The inguinal approach to extravesical ureteral reimplantation is safe, effective, and efficient. J Pediatr Urol. 2011;7:257–60.

    Article  PubMed  Google Scholar 

  59. Smith FL, Ritchie EL, Maizels M, Zaontz MR, Hsueh W, Kaplan WE, et al. Surgery for duplex kidneys with ectopic ureters: ipsilateral ureteroureterostomy versus polar nephrectomy. J Urol. 1989;142:532-534-543.

  60. Levy JB, Vandersteen DR, Morgenstern BZ, Husmann DA. Hypertension after surgical management of renal duplication associated with an upper pole ureterocele. J Urol. 1997;158:1241–4.

    Article  CAS  PubMed  Google Scholar 

  61. Husmann DA. Renal dysplasia: the risks and consequences of leaving dysplastic tissue in situ. Urology. 1998;52:533–6.

    Article  CAS  PubMed  Google Scholar 

  62. Lashley DB, McAleer IM, Kaplan GW. Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication. J Urol. 2001;165:552–4.

    Article  CAS  PubMed  Google Scholar 

  63. Leavitt DA, Rambachan A, Haberman K, DeMarco R, Shukla AR. Robot-assisted laparoscopic ipsilateral ureteroureterostomy for ectopic ureters in children: description of technique. J Endourol. 2012;26:1279–83.

    Article  PubMed  Google Scholar 

  64. • Biles MJ, Finkelstein JB, Silva MV, Lambert SM, Casale P. Innovation in robotics and pediatric urology: robotic ureteroureterostomy for duplex systems with ureteral ectopia. J Endourol. 2016;30:1041–8. This publication demonstrates the safety of RALUU, with no complications or reoperations among 12 patients with duplex collecting systems.

  65. González R, Piaggio L. Initial experience with laparoscopic ipsilateral ureteroureterostomy in infants and children for duplication anomalies of the urinary tract. J Urol. 2007;177:2315–8.

    Article  PubMed  Google Scholar 

  66. Kutikov A, Nguyen M, Guzzo T, Canter D, Casale P. Laparoscopic and robotic complex upper-tract reconstruction in children with a duplex collecting system. J Endourol. 2007;21:621–4.

    Article  PubMed  Google Scholar 

  67. •• Lee NG, Corbett ST, Cobb K, Bailey GC, Burns AS, Peters CA. Bi-institutional comparison of robot-assisted laparoscopic versus open ureteroureterostomy in the pediatric population. J Endourol. 2015;29:1237–41. This important series compares RALUU to open UU, and demonstrates no statistically significant difference in mean operative times or complication rates, with RALUU patients having a 0.5 day shorter hospital stay.

  68. •• Dangle PP, Akhavan A, Odeleye M, Avery D, Lendvay T, Koh CJ. Ninety-day perioperative complications of pediatric robotic urological surgery: a multi-institutional study. J Pediatr Urol. 2016;12:102.e1–6. This large mutli-institutional series documents complications among pediatric robotic procedures, including RALHN and RALUU, demonstrating similar complication rates.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Ming-Hsien Wang for the assistance with magnetic resonance urography discussion and images.

Author information

Authors and Affiliations

  1. Department of Urology, Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Jason E. Michaud & Ardavan Akhavan

  2. Charlotte R. Bloomberg Children’s Center, Johns Hopkins University, 1800 Orleans St., Bloomberg 7308-B, Baltimore, MD, 21287, USA

    Ardavan Akhavan

Authors
  1. Jason E. Michaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ardavan Akhavan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ardavan Akhavan.

Ethics declarations

Conflict of Interest

Jason E. Michaud and Ardavan Akhavan each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Michaud, J.E., Akhavan, A. Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters. Curr Urol Rep 18, 21 (2017). https://doi.org/10.1007/s11934-017-0664-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-017-0664-0

Keywords

Search

Navigation