The management of a poorly functioning kidney associated with primary VUR is nephrectomy with total or proximal ureterectomy. The retroperitoneal laparoscopic approach is particularly beneficial owing to a small residual distal ureteral stump (DUS) shorter than that achievable via a single flank incision. However, it does not allow the stump dissection down to the bladder base.[1] The transperitoneal laparoscopic approach is preferable for total removal of the ureter.[2]

Reflux in DUS is a rare complication due to partial excision of ureter. Recurrent UTI after nephrectomy is a useful signal to suspect the presence of reflux in DUS which act as a reservoir resulting in stasis and infections.[4] A long stump could be a risk factor in the pathogenesis of ureteric stump syndrome. A long refluxing stump inevitably acts as a diverticulum from which the urine cannot be effectively drained thus leading to outbreaks of UTI.[3] In our case a short ureteral stump became symptomatic due to reflux into it. We recommend transperitoneal laparoscopic approach for the management of a poorly functioning kidney which allows nephrectomy and complete ureterectomy up till the bladder base thus avoids reflux into the DUS.

Source of Support: Nil

Conflict of Interest: None declared