Using the renal pelvis flap to replace the whole hypoplastic ureter: a preliminary report

Abstract

Background Hypoplastic ureter is a rare condition usually associated with hypoplastic kidney, and it ends with nephrectomy in most of the cases. Many techniques have been described as ureteric substitutes in the literature. Here, we describe a new technique using the renal pelvis flap to replace the whole hypoplastic ureter in two cases. Objective The aim of this study was to describe a new surgical technique in the management of ureteric hypoplasia.
Patients and methods Of the two boys diagnosed antenatally, unilateral hydronephrosis was detected in one boy and a huge renal cyst was present in the other, with evidence of postnatal progressive obstruction necessitating surgical intervention. On exploration, hypoplastic ureter throughout its entire length was an accidental intraoperative finding. The renal pelvis flap was taken and tubularized to replace the entire ureter, and reimplanted into the urinary bladder. This technique was the primary procedure in one case, whereas it was the secondary procedure in the other case after failure of initial trial of pyeloplasty.
Results The postoperative period was uneventful with adequate drainage of the renal pelvis in the short-term follow-up (6 and 3 months consecutively).
Conclusion The renal pelvis flap is a new feasible alternative procedure for ureteric replacement in a hypoplastic ureter when there is preserved renal parenchyma.

Keywords: renal pelvis flap, ureteral hypoplasia, ureteric replacement