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S17-8 (PP)
CLINICAL OUTCOMES AND THE FATE OF THE UPPER
URINARY TRACT AFTER URETERAL CLIPPING
FOR THE TREATMENT OF LOW-FUNCTIONING KIDNEYS
OR NON-FUNCTIONING UPPER POLE RENAL MOIETIES
ASSOCIATED WITH ECTOPIC URETER OR OBSTRUCTIVE
URETEROCELE
Roberto IGLESIAS LOPES
1
, Jose Nicolas FERNANDEZ
1
, Joana DOS SANTOS
1
,
Jaime PEREZ
2
, Martin Allan KOYLE
1
and Armando Jose LORENZO
1
1) The Hospital for Sick Children, University of Toronto, Division of Urology, Department of Surgery, Toronto, CANADA
- 2) Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Division of Urology, Department of Surgery,
Bogota, COLOMBIA
PURPOSE
Evaluate clinical outcomes and hydronephrosis evolution after ureteral clipping for the treatment of
low-functioning kidneys or non-functioning renal moieties associated with ectopic ureter or obstruc-
tive ureterocele.
MATERIAL AND METHODS
Prospectively data collection on 25 consecutive patients (17 female, 8 male) who underwent
ureteral clipping between 02/2011 and 08/2016. Patients were divided in four groups [1: duplex
kidney with ectopic ureter (48%); 2: duplex with large ureterocele (16%); 3: duplex with progressive
upper pole dilatation (12%); 4: single-system low or non-functioning kidneys (24%)] and followed
postoperatively for clinical outcomes and trends in hydronephrosis of the ligated units over time.
RESULTS
Median age at surgery was 67 months (range: 5-205). Mean operative time was 106.6±33.7 min
(range: 20-180) and length of stay 12.1±7.7 hours. Immediate resolution of urinary incontinence
was observed in all cases of duplex systems associated with ectopic ureters (10 pts). After a mean
follow-up of 24.4±14.7 months, 96% of the patients remained asymptomatic. No significant difer-
ences were observed between the initial and last measures of pelvis anteroposterior (9 and 17 mm)
and ureteral diameter (9.5 and 14 mm). All ureteroceles showed a significant decrease after clip-
ping (27.2 ± 4mm to 5.3±9.2mm, p=0.007). One patient (4%) developed pyonephrosis two months
postoperatively and required a laparoscopic nephrectomy.
CONCLUSIONS
Ureteral clipping is a safe and effective treatment in this setting, with the obvious advantage of being
a much simpler and quicker surgical approach over extirpative or reconstructive porcedures.