Over a 6 year period, 16 girls with a mean age of 6.2 years presented with urinary incontinence accompanied by regular voiding. One of the patients had vaginitis along with their presentation of incontinence. Radiologist studies including ultrasonography, intravenous urography, and a DMSA renal scan showed a presence of only a single kidney in all cases. They were further studied with computer tomography showing a dysplastic kidney definitively in 9 patients and structures suspicious of a dysplastic kidney in 3 cases while there were no dysplastic kidneys in 4 cases. In the 4 cases were the CT scan was inconclusive, an MRI study was performed and it showed a suspicious lesion in only 1 of these patients. The other 3 had no findings at all. All the patients underwent a transperitoneal laparoscopic exploration and nephrectomy for dysplastic kidney as the cause of the incontinence.

Laparoscopically the group identified all the dysplastic kidneys easily, even in the those where the MRI could not find the kidney preoperatively. A nephroureterectomy was performed successfully in all 16 patients. There mean operative time was 109 minutes ranging from 40-155. There was no intra-operative bleeding. The man hospital stay was 2.6 days ranging between 2-4 days. There was 1 intra-operative complication which a small bowel injury occurred during and open Hasson's technique for Trocar introduction. This was managed successfully without any sequela. All the patients became dry immediately after the operation.

The group concluded that laparoscopic nephroureteroectomy for an ectopic ureter draining from a dysplastic segment is a safe and effective method. They also feel that laparoscopic evaluation should be considered even if preoperative imaging results failed to localize the dysplastic segment. In this scenario, one always makes the argument if the ureter really needs to be removed. It has been my experience that leaving these stumps in place only lends towards infection. Since the exposure laparoscopically is unparallel, I am a proponent of removing the entire system even in the case of duplicated ureters. In cases of a single system, I feel there is no question and an entire nephrouretectomy should be performed. Nonetheless this dilemma will continue as the literature is debatable between the true effectiveness of leaving stumps or removing them as far as urinary tract infection is concerned.

Byong Chang Jeong, Dae Jung Lim, Sang Chul Lee, Hwang Choi, Hyeon Hoe Kim

International Journal of Urology. 14(2): 104-107, February 2007.

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Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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