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• W2032505875 abstract "Background It is crucial to preserve the renal parenchyma in a solitary renoureteric system, especially when associated with VUR and/or elevated bladder pressures. Aim The present study examined the effect of retaining the refluxing lower ureteral stump of a non-functioning renal unit (during nephrectomy) as a stoma to preserve contralateral renal function. Study design Twelve children with various uropathologies (six with PUV, three with primary VUR, and three with neurogenic bladder) and a solitary functioning kidney were retrospectively analysed. In each, besides the relevant investigations and specific management, nephrectomy was performed for a non-functioning kidney with recurrent UTI (10/12) or hypertension (2/12), and the ipsilateral distal ureteric stump was exteriorised as a refluxing stoma. Antimicrobial prophylaxis was given to those with VUR into the solitary kidney (9/12). All were on strict follow-up at a dedicated paediatric nephrourology clinic with serial clinical, biochemical and radiological surveillance. Results The mean age at presentation and surgery was 19.7 months (range 0.5–96) and 30.5 months (range 3–100), respectively. Recurrent UTI (10/12) and acute renal failure (8/12) were common presentations; 2/12 were hypertensive. The initial serum creatinine ranged from 0.3 to 7.2 (mean 2.3) mg/dl. Of the solitary functioning kidneys with VUR (9/12), seven had Grade 5 VUR and six had renal cortical scars. The stoma served as an intermittent vent (9/12), for CIC (4/12) or for both purposes (3/12). Although all were Grade 5 refluxing ureters, 3/12 stomas remained dry. At a mean follow-up of 30 months (12–48), 9/12 were well and 3/12 were in end-stage renal disease. None had a UTI after the procedure. VUR resolved in five ureters that sub-served the contralateral solitary kidney. Serial DMSA renal cortical scans showed no scarring in four children, non-progressive scars in three and new scars in two. At the last follow-up, four (one dry, three leaking) were being used for CIC, four (one dry, three leaking) had been closed and four (one dry, three leaking) were retained until resolution of contralateral reflux/non-progression of scarring (three) or for possible CIC in the future (one). Discussion and conclusion It is crucial to preserve the renal parenchyma in a solitary renoureteric system, especially when associated with VUR and/or elevated bladder pressures. The present study examined the effect of retaining the refluxing lower ureteral stump of a non-functioning renal unit (during nephrectomy) as a stoma to preserve contralateral renal function. Twelve children with various uropathologies (six with PUV, three with primary VUR, and three with neurogenic bladder) and a solitary functioning kidney were retrospectively analysed. In each, besides the relevant investigations and specific management, nephrectomy was performed for a non-functioning kidney with recurrent UTI (10/12) or hypertension (2/12), and the ipsilateral distal ureteric stump was exteriorised as a refluxing stoma. Antimicrobial prophylaxis was given to those with VUR into the solitary kidney (9/12). All were on strict follow-up at a dedicated paediatric nephrourology clinic with serial clinical, biochemical and radiological surveillance. The mean age at presentation and surgery was 19.7 months (range 0.5–96) and 30.5 months (range 3–100), respectively. Recurrent UTI (10/12) and acute renal failure (8/12) were common presentations; 2/12 were hypertensive. The initial serum creatinine ranged from 0.3 to 7.2 (mean 2.3) mg/dl. Of the solitary functioning kidneys with VUR (9/12), seven had Grade 5 VUR and six had renal cortical scars. The stoma served as an intermittent vent (9/12), for CIC (4/12) or for both purposes (3/12). Although all were Grade 5 refluxing ureters, 3/12 stomas remained dry. At a mean follow-up of 30 months (12–48), 9/12 were well and 3/12 were in end-stage renal disease. None had a UTI after the procedure. VUR resolved in five ureters that sub-served the contralateral solitary kidney. Serial DMSA renal cortical scans showed no scarring in four children, non-progressive scars in three and new scars in two. At the last follow-up, four (one dry, three leaking) were being used for CIC, four (one dry, three leaking) had been closed and four (one dry, three leaking) were retained until resolution of contralateral reflux/non-progression of scarring (three) or for possible CIC in the future (one)." @default.
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• W2032505875 date "2015-06-01" @default.
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• W2032505875 title "Retaining the refluxing lower ureteral stump of a non-functioning kidney to preserve contralateral renal function" @default.
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• W2032505875 doi "https://doi.org/10.1016/j.jpurol.2015.02.016" @default.
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