Mumtaz H Khan, Naila Yaqub.
Partial Nephroureterectomy and drainage of Ureterocele - A safe method for Congenital Abnormalities of Urinary Tract.
J Coll Physicians Surg Pak Jan ;11(5):340-2.

A five years female child was admitted at Islamic International Medical Complex (IIMC), Islamabad, with history of recurrent urinary tract infections and failure to thrive. She was diagnosed as a case of right renal duplication associated with nonfunctioning upper pole, Pelvi-ureteric junction (PUJ) obstruction of lower moiety and ureterocele. Right partial nephroureterectomy with drainage of right ureterocele was done. Right PUJ obstruction of lower moiety was confirmed to be due to external pressure of hydronephrotic upper pole. The patient had an uneventful course and was discharged for home on 5th postoperative day. At follow-up patient was asymptomatic and growing well. The remaining right kidney (lower moiety only) was functioning well and no more hydronephrotic. The aim of this case report is to present partial nephrouretectomy and drainage of ureterocele only as a safe method in children for treatment of obstructive ureterocele associated with duplicated ureters and a non-functioning upper pole.

Case Report: A five years old female child was admitted with history of recurrent urinary tract infections since six months of age and failure to thrive. She had been receiving antibiotics off and on by the treating physician during that period. Urine examination showed numerous pus cells. Right renal duplication with severe hydronephrosis of upper pole and mild hydronephrosis of the lower moiety and right ureterocele was diagnosed on U/S. Some excretion of contrast was seen on right side with normal functioning left kidney on IVU. Micturiting cystourethrogram confirmed right ureterocele and ruled out VUR. Isotopic renal scan revealed nonfunctioning right upper pole with pelvi-ureteric junction (PUJ) obstruction of lower moiety. The comparative function of right lower moiety was found to be 38%. At operation upper pole was found to be a bag of urine with covering of paper-thin cortex.

The ureter draining the upper pole was grossly dilated and tortuous. The ureter was divided at the PUJ and urine from the upper pole (about 400 ml) was drained out which resulted in collapse of upper pole like a balloon. This made the differentiation between nonfunctioning and normal kidney very easy. Right partial nephrectomy and ureterectomy was done. The ureterocele having confirmed to be obstructed at bladder side was drained. The PUJ of the remaining lower pole was found to be patent after removal of external pressure being exerted by hydronephrotic upper pole with its normal ureter. Postoperative recovery was uneventful and the patient was discharged for home on 5th postoperative day. At follow-up of two months, the child was asymptomatic and growing well. The urine examination is normal. There is no hydronephrosis of the remaining lower moiety of right kidney on U/S examination.

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