Complications of the ureteral stump after upper tract approach treatment of duplex systems in children

Purpose: Ectopic ureter or ureterocele is the most common upper urinary tract anomaly associated with duplex kidneys, and is usually treated by heminephrectomy and ipsilateral ureteroureterostomy in case of obstruction or reflux. However, the development of residual ureteral stump infection is a major concern. We reviewed the long-term outcome of residual ureteral stumps in children with duplex kidneys after surgery. Materials and Methods The medical records of 203 pediatric patients with duplex kidney who underwent upper pole heminephrectomy or ipsilateral ureteroureterostomy between January 2010 and December 2019 were reviewed retrospectively. we evaluated preop diameter of the renal pelvis and ureteral on ultrasonography, preop history of urinary tract infections (UTIs), presence of preop vesicoureteral reflux (VUR), type of anomaly, type of surgical operation, preop differential renal function in these patients. Results During a follow-up of 36 months, 16 patients had recurrent UTIs at the residual ureteral stump after upper pole heminephrectomy, of which 11 underwent stump resection. Antibiotic treatment resolved the UTIs in the remaining 5 patients. Stump resection was not required in any of the patients who underwent ipsilateral ureteroureterostomy (IUU). Conclusions Most patients with residual ureteral stumps after upper tract surgery do not require stump resection at long-term follow-up. The length of residual ureteral stump is significantly correlated to ureteric stump syndrome, those with risk factor should be followed carefully at least for 12 months for ureteric stump syndrome after surgery.