Role of heminephrectomy for poorly functioning upper pole of complete duplex systems in children.

introductionThe management of duplex renal systems remains controversial. Depending on patient characteristics, conservative management, minimally invasive techniques, or open surgery may be considered, each offering distinct advantages and limitations. In this study, we aimed to present the outcomes of upper-pole heminephrectomy for poorly functioning moieties in duplex systems while preserving the lower urinary tract. MATERIALS AND

methodsAll patients underwent routine clinical evaluation, including medical history, physical examination, biochemical tests, and radiological imaging. Surgical intervention was indicated in symptomatic patients or based on shared decision-making after counseling the parents. Thirty-six patients who underwent upper-pole heminephrectomy between 2014 and 2024 were retrospectively analyzed with respect to demographic characteristics, preoperative and perioperative findings, and postoperative follow-up. Postoperative outcomes were classified as short-term and long-term. Patients who required reoperation were compared with those who did not.

resultsThe cohort consisted of 28 female and 8 male children with a mean age of 36.1 ± 39.5 months at the time of surgery. In the short term, only one patient required reoperation due to suspected urinary leakage. Over a mean postoperative follow-up of 29.83 ± 31.50 months, eight patients underwent additional procedures: two stump excisions, five endoscopic interventions, and one open anti-reflux surgery. All six patients who required anti-reflux intervention were female and had high-grade vesicoureteral reflux (VUR) prior to heminephrectomy. Younger age at surgery and preoperative VUR were identified as significant risk factors for reoperation.

conclusionsUpper-pole heminephrectomy prevented the need for open bladder surgery in 97% of patients during follow-up. However, parents of female patients and those with high-grade VUR should be counseled regarding the increased risk of secondary procedures related to postoperative VUR and febrile urinary tract infections. The likelihood of additional surgery during follow-up appears to be primarily driven by the preoperative VUR status.