THE METHOD OF TOTAL HEMINEPHROURETERECTOMY

Application of Mucolysis

Abstract

Double ureters are not a rare anomaly. In the great majority of duplex-ureter systems, both components are functionally normal. Some may present medical problems such as abdominal cystic masses and recurrent urinary tract infections, even from the newborn period. The choice of the best method of the operation depends on residual renal function, the form of ureters, the shape and the position of the ureter orifice, and other factors. So, there are many methods by which to operate on duplex-ureter systems. Total heminephroureterectomy may be the best method of choice, if the duplex-ureter portion is non-functional. It is however, very difficult to resect the pathological ureter with the mate ureter uninjured, when the mate is covered by a common sheath or the patient is very small. Recently, two patients were admitted to our hospital because of abnormal findings of intrauterine echogram. One of them had a large ureterocele with a dilated ureter whose upper pole duplex kidney was non-functioning and cystic. The other patient had an upper ureter orifice opening ectopically to vagina, a ureter dilated, and a non-functioning upper pie duplex kidney. For heminephroureterectomy, resection of the upper one-fourth of the upper pole ureter was easy. But further excision of ureter seemed threatening to the mate ureter. We applied the mucolysis method, which we had been using as the operation of Sowve's method for the patients with Hirschsprung diseases. The method was technically easy and safe. There have been no complications after 1 year of follow up.