Ectopic ureters in the presence of an upper moiety duplex kidney, or non functioning upper moieties, are traditionally treated with a heminephrectomy (open or laparoscopic). This carries significant risks, especially loss of the remaining lower moiety. These authors describe a novel method of treatment with less risk to the lower moiety. It involves clipping the upper moiety ureter only and leaving the non functioning moiety in situ on the assumption that the associated ‘acquired obstruction’ will ultimately cause it to shrink. Nine girls (median age 8 years, range 4- 17) were treated in this way (cystoscopy, stenting normal ureter, laparoscopy and clipping abnormal ureter). All patients were immediately dry after the procedure and on follow-up (maximum 27 months) eight developed some mild degree of asymptomatic upper moiety renal dilation. The authors conclude that this is a safe procedure with encouraging short-term results but further long-term follow-up is needed to determine its long-term efficacy and safety.
Laparoscopic ureteral ligation (clipping)
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