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| Clinical features and management of ureteric stump syndrome: Single-centre experience and contemporary literature review |
Krishnendu Biswas*( ),Abhishek G. Singh,Arvind P. Ganpule*(),Ravindra B. Sabnis,Mahesh R. Desai
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| Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India |
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Abstract “Ureteric stump syndrome(USS)” is a rare entity (incidence 0.8%–1.0%) with left-over in situ distal-ureter being the culprit [[1], [2], [3]]. The presentation may be recurrent urinary tract infection (UTI), flank/abdominal pain, or hematuria [1,4]. Although only few of the patients require intervention (approximately 1.1%–10%) [[1], [2], [3]], either with open excision of the stump [[1], [2], [3]] or via minimally invasive endoscopic approach [5,6], prompt diagnosis is often delayed. During simple nephrectomy, dilemma exists whether to consider concomitant total ureterectomy to eliminate the future risk of USS [4], or to consider subtotal-ureterectomy along with nephrectomy [[1], [2], [3]]. In this letter, we present a retrospective analysis of clinical presentation, diagnostic approach, and management of three patients of USS (Table 1) treated at our centre and try to solve all these dilemmas.
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Available online: 20 April 2022
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Corresponding Authors:
Krishnendu Biswas,Arvind P. Ganpule
E-mail: krish.biswas@yahoo.com;doctorarvind1@gmail.com
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| Characteristic | Case I | Case II | Case III | | Age, year | 16 | 27 | 71 | | Gender | Male | Female | Male | | Presentations | Fever (post renal transplant) | Discharging sinus from wound | Hematuria | | Past history | Bilateral open pre-transplant nephrectomy (in an operated case of left to right transureteroureterostomy with right ureteric reimplantation) | Left open simple nephrectomy (non-functioning left kidney due to ureteric stone) | Left laparoscopic nephroureterectomy (including the stricture part for left non-functioning kidney due to ureteric stricture [histopathology: Chronic ureteritis]) | | Interval between past surgery and present complaints, month | 6 | 4 | 3 | | Present diagnosis | Right ureteric stump abscess | Uretero-cutaneous fistula with retained left ureteric stone | TCC of left distal ureteric stump | | Procedure performed | Open right distal ureterectomy | Laparoscopic left distal ureterectomy | Robotic left completion ureterectomy with radical cystectomy with ileal conduit | | Length of stay, day | 7 | 2 | 9 | | Complication | Fever for 3 days | None | Readmission with sepsis with AKI at 1 month | | Follow-up, month | 48 | 24 | 8 | | Present status | Asymptomatic | Asymptomatic | Asymptomatic |
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Data of three patients with ureteric stump syndrome.
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Computed tomography images of patients with ureteric stump syndrome. (A) Right renal fossa collection (transverse view); (B) Right renal fossa collection (coronal view); (C) Uretero-cutaneous fistula (coronal view); (D) Uretero-cutaneous fistula (transverse view); (E) Uretero-cutaneous fistula with retained stone in the left ureter; (F) Left vesico-ureteric junction region and distal left ureter mass (transverse view); (G) Left vesico-ureteric junction region and distal left ureter mass (sagittal view).
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Algorithm of approach to ureteric stump syndrome. USS, ureteric stump syndrome; UTI, urinary tract infection; LUTS, lower urinary tract infection; s/o, suggestive of; C/S, culture & antibiotic sensitivity; TB, tuberculosis; USG KUB, ultrasonography kidney-ureter-bladder; CT IVP, computed tomography with intravenous pyelography; MCUG, micturating cystourethrogram; CECT, contract enhanced computed tomography; RGP, retrograde pyelography.
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