Background: Measurement of treatment outcome is important in estimating the success of cleft management. The aim of this study was to assess the surgical outcome of cleft lip and palate surgery. Patients and Methods: The surgical outcome of 131 consecutive patients with cleft lip and palate surgeries between October 2008 and December 2010 were prospectively evaluated at least 4 weeks postoperatively. Data collected included information about the age, sex, type of cleft defects, and type of surgery performed as well as postoperative complications. For cleft lip repair, the Pennsylvania lip and nose (PLAN) score was used to assess the surgical outcome, while the integrity of the closure was used for cleft palate repair. Results: A total of 92 patients had cleft lip repair and 64 had palate repair. Overall, 68.8% cases of cleft lip and palate repair had good outcomes; 67.9% of lip repairs had good lip and nose scores, while 70.2% of palatal repair had a good surgical outcome. Oro-fistula was observed in 29.8% of cleft palate repairs Inter-rater reliability coefficient was substantially significant. Conclusions: The fact that 25.7% of those treated were aged >1 year suggests a continued need to enlighten the public on the availability of cleft lip and palate expertise and treatment. Although an overall good treatment outcome was demonstrated in this study, the nasal score was poorer than the lip score. Complication rate of about 14% following surgical repair is consistent with previous reports in the literature.

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Sigmoid volvulus (SV) is an extremely rare cause of bowel obstruction in the newborn period. We report a neonatal case of SV misdiagnosed as small bowel volvulus. At laparotomy, the classical findings of SV were observed without gangrene. The operative procedure consisted of simple detorsion without sigmoidopexy.

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Background: Recurrent intussusceptions in child and infants are problematic and there are controversies about its management. The aim of this study is to determine the details of the clinical diagnosis of recurrent intussusception and to determine the aetiology of recurrent intussusceptions. Patients and Methods: It's a retrospective study of 28 cases of recurrent intussusception treated in the paediatric surgery department of Monastir (Tunisia) between January 1998 and December 2011. Results: During the study period, 505 patients were treated for 544 episodes of intussusception; there were 39 episodes of recurrent intussusceptions in 28 patients; the rate of patients with recurrence was 5.5%. With comparison to the initial episode, clinical features were similar to the recurrent episode, except bloody stool that was absent in the recurrent group (P = 0,016). Only one patient had a pathologic local point. Conclusion: In recurrent intussusception, patients are less symptomatic and consult quickly. Systematic surgical exploration is not needed as recurrent intussusceptions are easily reduced by air or hydrostatic enema and are not associated with a high rate of pathologic leading points.

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Background: The definitive treatment of Hirschsprung's disease is the removal of the aganglionic bowel by a pull-through surgery. In most cases, this surgery is performed in infancy or in the neonatal period as presentation in older children and adulthood is uncommon. Materials and Methods: It is a retrospective study of 20 patients above two-year-old who underwent a transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease between January 2002 and December 2010. Results: Twenty patients were recruited in this study. Fourteen were males and six were females. Patient ages ranged from 2 to 14 years (median age: five years and three months). All patients presented with persistent constipation and abdominal distension. Two of them had an intestinal obstruction that required colostomy. Ten patients (50%) had a recto-sigmoid Hirschsprung's disease. All patients were operated on using a Soave one-stage endorectal pull-through procedure. The laparoscopy was necessary during the pull-through in three cases. The average duration of the intervention was 240 minutes. That represents almost the double of the duration of the same procedure in newborns and infants in our department (130 minutes). Early postoperative complications included one case of anastomosis leakage and one case of intussusception. Late postoperative complications were perineum irritation in five cases (25%), anal stenosis in four cases (20%) and enterocolitis in one case (5%). None of our patients developed fecal incontinence. Soiling was reported in four cases (20%). There was no death. Conclusion: Soave transanal one-stage endorectal pull-through is safely feasible in children of more than two years of age. Laparoscopy may be necessary whenever there are difficulties in the pull-through.

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Background: The diagnosis of varicocèle is clinical. In order to improve diagnosis of varicocele, we compared the clinical with the ultrasound findings in schoolboys with the condition. This is because the conditions can affect testicular growth. Patients and Methods: It was a cross-sectional, descriptive study of schoolboys aged from 10 to 19 years who had varicocele. Among 2724 boys examined, 149 had varicocele and only 81 had scrotal (18 with Doppler) and renal ultrasound examination. Results: Among the 81 adolescents who were clinically diagnosed with varicocele and also with the aid of ultrasound scan, 25, 36 and 20 had grade 1, 2 and 3, respectively. Testicular hypotrophy (TH) was clinically noticed in 17 cases. At ultrasonography, varicocele was bilateral in 87.66% and unilateral in 12.34% (P = 0.01) with 32 adolescents (39.51%) showing TH compared with 20.99% being diagnosed with TH using clinical examination alone (P = 0.01). In 50 schoolboys (61.73%) with unilateral varicocele, a subclinical type was discovered at other side. Renal ultrasound revealed abnormalities in 4.93% of cases. Doppler ultrasound helped in finding varicoceles along the top edge of the testis (n = 15) and under tunica albuginea (n = 3). Conclusion: TH due to varicocele is better studied by ultrasound.

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Background: To describe our experience of paediatric patients with acute retropharyngeal abscess in terms of clinical presentation, diagnosis, management and complications. Materials and Methods: A prospective study was done for a period of 4 years (Jan 2009 to Jan 2013) on paediatric patients (< 15 years) with acute retropharyngeal abscess at two tertiary hospitals in Srinagar. Diagnosis was made on the basis of X-ray, CECT scan findings and confirmed on incision and drainage. Pus was aspirated from all patients and sent for culture and sensitivity. Data for clinical presentation, X-ray, CECT scan findings, causes, complications, bacteriology and management were collected. Thirty-five abscesses were drained while 5 with small abscesses on CECT were managed conservatively. Results: A total of 40 patients were diagnosed as acute retropharyngeal abscesses. Males were commonly affected, and most of the patients were less than 6 years of age. Most common symptom at presentation was fever (35) followed by neck pain (30) Dysphagia/odynophagia (22), swelling in neck (19). Most common clinical sign observed was oropharyngeal swelling and limitation of neck movements (30), cervical swelling/lymphadenopathy in 22 patients. Torticollosis and drooling were seen in 15 patients. Complications were seen in 8 patients. Most common X-ray finding was pre-vertebral thickening. Success rate with primary surgical drainage was 95% while 3 patients in conservative group failed. Conclusion: Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Surgical intervention is necessary for most of these patients.

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Frequently lower limb injuries are caused by road and work accidents. The young age of those affected coupled with the anatomical and functional peculiarities of this part of the body with regards to social life during adolescence make the treatment of the leg wound complex and challenging. We present two cases of young girls, victims of serious road accidents who were treated initially with frequent wound washings, vacuum therapy to stimulate granulation tissue, then dermal regeneration matrix (INTEGRA ^® ) and split-thickness skin grafts. After one year, both patients treated with lipofilling have shown improved cosmetic results allowing a new social life.

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Background : The aim of this study was to investigate the circumstances surrounding unintentional injuries of children and the appropriateness of the first aid provided by caregivers. Materials and Methods : This prospective study included children with aged range 0-12 years, who presented with an unintentional injury at the Trauma Unit of a hospital in Cape Town, South Africa, over a 3 month period. Caregivers were interviewed about the circumstances of the injury and the first aid provided. Experts classified the first aid as appropriate, appropriate but incomplete, or inappropriate. Results: A total of 313 children were included with a median age of 3.75 years. The most common causes of injury were falls (39.6%, n = 124), burns (23.9%, n = 75) and motor vehicle crashes (10.5%, n = 33). More than a quarter of the children (27.2%, n = 81) had been left under the supervision of another child below the age of 12. When the injury occurred, 7.1% (n = 22) of the children were unattended. First aid was provided in 43.1% (n = 134) of the cases. More than half of these interventions (53%, n = 72) were inappropriate or appropriate but incomplete. Conclusions: Especially young children are at risk for unintentional injuries. Lack of appropriate supervision increases this risk. Prevention education of parents and children may help to protect children from injuries. First-aid training should also be more accessible to civilians as both the providing of as well as the quality of first-aid provided lacked in the majority of cases.

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Volvulus and intussusception are rare conditions in children. We describe an unusual case of intussusception due to a solitary Peutz-Jeghers type hamartomatous polyp complicated by volvulus, which occurred in an 11-year-old girl. A laparotomy allows to successfully treat the pathology. The postoperative course was favourable. We discuss the clinical findings and the values of the preoperative instrumental diagnosis. The literature is reviewed. Identifying a midgut volvulus, as complication of a small bowel intussusception, during the diagnostic phase could help in choosing the most appropriate surgical approach.

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Background: Anorectal malformations (ARMs) affect 1 in 4000-5000 births and are a big challenge in western countries. However, little is known about ARMs in Africa. The aim of this study is to evaluate the incidence, treatment and outcome of ARMs in Malawi. Materials and Methods: Over a 4-year period (2006-2009), data was extracted from patients up to and including the age of 5 years or less who underwent a colostomy, posterior sagittal anorectoplasty or colostomy closure. Results: Of the data that could be retrieved 46 patients met the criteria of congenital ARMs; 65.2% were female (N = 30) and 34.8% were male (N = 16). The median distance from patient to the hospital was 79 km and the median age at presentation was 24 days. In female patients: The most common ARM was the vestibular fistula (N = 21; 70%), a recto-vaginal fistula was found four times, a cloaca was found three times and a perineal fistula or no fistula were both found once each. The most common ARM among boys was the recto-urethral fistula (N = 10). Two boys had no fistula. A perineal fistula and a recto-vesical fistula were both found once each. Nearly, half of the patients (N = 22) had complications. Complications occurred less often in the group, which lived closest to the Surgical Unit (25%). Associated anomalies were found in one patient. Conclusion: This study shows a skewed distribution of age at presentation and type of ARM. The most likely explanations are (1) the distance to the hospital: Because none of the male patients presented after 4 weeks and many may have passed away before arriving at the tertiary care centre; (2) lack of knowledge among primary caregivers since very few patients with rectoperineal fistulas were seen. The rate of complications was high, probably also related to advance age at presentation. Therefore, Malawi needs more awareness for earlier detection and quicker intervention.

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Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS) done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary) and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390) of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision) surgery. The most common surgical technique employed was modified Fork flap (Millard) technique, which was employed in 37 (95%) cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

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In children with long gap oesophageal atresia (LGEA), the FOKER technique (oesophageal elongation with traction sutures) has been criticized for its high complication rate. We advocate analysing such problems to increase the safety in the future. The present case report will focus on timing. A female newborn (3000 g) with LGEA (gap of 5 cm) was delivered in an outward hospital. On day two of life, she received traction sutures on both pouches. By day five, all sutures had torn out, and a primary anastomosis was attempted. However, it leaked severely. Thus, on day ten, the oesophagus was approached from the neck converting the proximal end into a spit fistula and closing the distal end blindly. Furthermore, the gastro-oesophageal (GE-) junction was wrapped with a Teflon sling. When the baby arrived in our institution, she suffered from cavernous oesophageal masses extending from the thoracic inlet down to the diaphragm and fistulas draining them into the neck as well as into the right lung. Moreover, the Teflon sling had dislodged allowing for GE-reflux. In several stages, the oesophageal remnants were resected without any complications. Finally, Prof. Alaa Hamza performed a colonic interposition, which is working well today. In conclusion, the present case aims to caution paediatric surgeons to apply traction sutures for oesophageal elongation in newborns with LGEA.

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Fetal pleural effusion is a rare condition. While it may regress spontaneously, it may also continue up to the post-natal period. This condition may be treated by thoracentesis, thoracoabdominal shunt application and pleurodesis in the intrauterine period while thoracentesis or tube thoracostomy may be used in the post-natal period. In cases where the fluid is defined to represent chylothorax, octreotide, a somatostatin analogue, may be administered for treatment. In this case report, we discussed the outcomes of treatment with octreotide administered in a neonatal case under follow-up due to fetal pleural effusion and with non-chylous ascites detected in the post-natal period.

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Background: Intestinal anastomosis in severely ill children with peritonitis from intestinal perforation, intestinal gangrene or anastomotic dehiscence (acute intestinal disease) is associated with high morbidity and mortality. Enterostomy as a damage control measure may be an option to minimize the high morbidity and mortality. This report evaluates the role of damage control enterostomy in the treatment of these patients. Materials and Methods: A retrospective review of 52 children with acute intestinal disease who had enterostomy as a damage control measure in 12 years. Results: There were 34 (65.4%) boys and 18 (34.6%) girls aged 3 days-13 years (median 9 months), comprising 27 (51.9%) neonates and infants and 25 (48.1%) older children. The primary indication for enterostomy in neonates and infants was intestinal gangrene 25 (92.6%) and perforated typhoid ileitis 22 (88%) in older children. Enterostomy was performed as the initial surgery in 33 (63.5%) patients and as a salvage procedure following anastomotic dehiscence in 19 (36.5%) patients. Enterostomy-related complications occurred in 19 (36.5%) patients, including 11 (21.2%) patients with skin excoriations and eight (15.4%) with hypokalaemia. There were four (7.7%) deaths (aged 19 days, 3 months, 3½ years and 10 years, respectively) directly related to the enterostomy, from hypokalaemia at 4, 12, 20 and 28 days postoperatively, respectively. Twenty other patients died shortly after surgery from their primary disease. Twenty of 28 surviving patients have had their enterostomy closed without complications, while eight are awaiting enterostomy closure. Conclusion: Damage-control enterostomy is useful in management of severely ill children with intestinal perforation or gangrene. Careful and meticulous attention to fluid and electrolyte balance, and stoma care, especially in the first several days following surgery, are important in preventing morbidity and mortality.

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Background: Injury has been recognised as a preventable cause of morbidity and mortality in children. The aim of this study was to determine the aetiology, pattern and location of childhood injuries in north east Nigeria. Materials and Methods: This is a 3-year retrospective hospital-based descriptive study. The study included 114 children (77 boys, 37 girls; mean age 6.4 ± 3.2 years; range 2 months to 15 years) who were admitted for various injuries in the female/paediatric surgical ward from January 2007 to December 2009. Information obtained from their case notes included demographic data, mechanism of injury, location of injury, anatomical site of injury and outcome of treatment. Results: Records for 114 children (77 boys, 37 girls; mean age 6.2 years; range 2 months to 15 years) were available for analysis. The highest number of injuries occurred in the age group 6-10 years. Home was the most common location of injury among the age group 0-5 years while older children sustained most of their injuries outside the home on the street/highways. Burns from hot water was the most common injury among children aged 0-5 years while pedestrian accident accounted for the highest cause of injury among older children. Fall accounted for 20.2% of the injuries. The most common specific anatomic injury was head injury followed by limb fractures. Two mortalities were recorded (1.8%). Conclusion: This study provided useful information on the characteristics of childhood injuries in our environment. There is the need for parents and children education about the risks of injury and preventive measures in addition to legislation and policy on environmental modifications and enforcements to significantly reduce childhood injury.

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Background: Paediatric head injury (HI) is the single most common cause of death and permanent disability in children world over, and this is increasingly becoming worrisome in our society because of increased risks and proneness to road traffic accidents on our highways and streets. The study set to determine causes and management of HI among children in our society. Patients and Methods: A retrospective review of all children aged 0-15 years with traumatic head injury (THIs) who were managed at the University of Maiduguri Teaching Hospital between July, 2006 and August, 2008. Results: A total of 45 children with THIs presented to the casualty unit of the hospital; 30 (66.7%) were boys and 15 (33.3%) were girls. Three (6.7%) children were less than 1 year of age, 21 (46.7%) were between 1 years and 6 years while 16 (35.6%) and 5 (11.0%) were aged 7-11 years and 12-15 years respectively. Thirty six (80.0%) of the children were pedestrians, 6 (13.4%) fell from a height, while 2 (4.4%) and 1 (2.2% were as a result of home accident and assault, respectively. Twenty one patients (46.7%) had mild HI, while 53.3% had moderate to severe category. Forty one (91.1%) of children were managed as in-patients, mostly (95.1%) by conservative non-operative management, while 4 (8.9%) were treated on the out-patient basis. The mortality rate was 17.8%. Conclusion: H1 among children is of a great concern, because of its incremental magnitude, due to increasing child labour and interstate religious discipleship among children, with attendant high mortality and permanent disabilities. Necessary laws and legislations should be formulated and implemented with organized campaigns and public enlightenment to prevent and mitigate this menace.

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Background: Extragonadal teratomas (EXGTs) are ubiquitous in the human body; hence, they have varied presentation. In underdeveloped areas presentation and management are affected by socio-economic, cultural and health facilities factors. The aim of this study was to review the outcome of management of complicated EXGT in a tertiary health centre. Materials and Methods: A review data of paediatric patients with EXGT was done between January 1999 and December 2012. Variables reviewed were bio-data, mode of presentation and site of tumour, comorbidity, treatments and outcome. The data was analysed with Statistical Package for Social Sciences (SPSS ^(R)) version 16.0. Results: There were 21 complicated EXGT (77.8%) among 27 children, age ranges from 4 days to 16 years (median = 2 years). Male:Female ratio of 1:2. The complications per region of the body at presentation were cervical 4 (66.7%), mediastinal 2 (100%), abdominal 3 (75%) and sacrococcygeal 12 (75%). The complications were respiratory distress 6, intestinal obstruction 5, faecal incontinence 2, bladder outlet obstruction 3, malignant transformation 5, ruptured sacrococcygeal teratoma 2, ulcerated tumour 2, anaemia 3 and malnutrition 3. There were 5 (23.8%) progressive disease post-excision outside our facility. Excision biopsy was successful in 19 (85%) patients two of which had neoadjuvant cytotoxic therapy. Overall mortality was 5 (23.8%) (septicaemia, anaemia, respiratory distress, renal failure) and post-excision mortality was 11.8% (endotracheal tube blockage and progressive disease). Conclusion: Delay presentation (due to local belief, ignorance and poverty) malnutrition, sepsis, malignant transformation characterised presentation of children in this study and the lack of paediatric intensive care unit facility and intensivists compromised survival of children with EXGT.

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Background: The objective of this study was to assess the significance of tunica vaginalis flap cover in cases of recurrent proximal penile fistula. Materials and Methods: This retrospective study included complicated cases of proximal penile hypospadias with recurrent fistula. Recurrent fistula was defined as fistula after at least two previous attempts of closure. Group 1 included cases with tunica vaginalis flap and Group 2 included cases with local flap. Outcome was assessed at day 10 after stent removal and at first follow-up. Fistula closure was considered successful in case with no leak. Results: Out of 39 cases of recurrent fistulas, 20 cases in Group 1 and 18 cases in Group 2 formed the study group. The mean age at fistula repair was 7.2 ± 0.9 years (range: 2.1-12 years) and 7.1 ± 0.7 years (range: 2.3-12 years) in Group 1 and 2 respectively. Leak at the time of stent removal was present in 1/20 (5%) and 3/18 (16.67%) cases in Group 1 and 2 respectively (P = 0.04). Leak at the time of first follow-up was present in 2/20 (10%) and 4/18 (22.22%) cases in Group 1 and 2 respectively (P = 0.03). Complete disruption of fistula closure was present in 1/20 (5%) and 2/18 (11.11%) cases in Group 1 and Group 2 respectively (P = 0.1). The overall success rate in Group 1 and 2 was 16/20 (80%) and 9/18 (50%) respectively (P = 0.01). Conclusions: Tunica vaginalis flap reinforcement is a viable and reliable option. With proper use cases of recurrent fistula can be managed successfully.

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Bilateral acalculus ureteric obstruction is described as rare sequelae of acute appendicitis in two paediatric patients aged 6 and 11 years presented with features of anuria. Imaging and endoscopic evaluation confirmed bilateral ureteric obstruction secondary to bladder wall oedema as an inflammatory reaction to appendix. Both cases recovered following bilateral ureteric stenting and are doing well.

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Background: The objective of this study was to assess effect of number of associated anomalies on outcome in oesophageal atresia with or without tracheoesophageal fistula patients. Materials and Methods: Retrospective analysis of records of neonates admitted with a diagnosis of oesophageal atresia (EA) with or without tracheoesophageal fistula during January 2005 to May 2011. Preoperative investigation included chest X-Ray, ultrasonography of abdomen and echocardiography. Associated anomalies were grouped as minor or major depending on whether life threatening or not. Major anomalies were further sub grouped according to the involvement of single, two or > 2 organ systems. Survival was correlated with the presence of anomalies and the number of systems involved. Results: Out of 301 patients with EA, 240 survived (79.7%). Of these 301, 117 (38.9%) had no associated anomalies. Of the total 61 deaths, 59% (36/61) were in patients with cardiac anomalies and 44% (27/61) were in those with >2 associated anomalies. The mortality rate was highest in those with >2 anomalies 27/34 (79.4%), whereas survival was best in those without any associated anomalies 104/117 (88.9%). Conclusions: Apart from other factors, an association of more than two system anomalies influence the mortality in oesophageal atresia.

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Background: There are many techniques in the reconstructive of congenital diaphragmatic hernia defect. In this study, we present our results from a prospective, randomised trial of using the omentum (omentopexy) for repair of large diaphragmatic defects. Materials and Methods: Twenty white, male, New Zealand rabbits were used to compare incidence and severity of adhesion bands formation in abdominal cavity with/without of omentopexy after repair of diaphragm defect with the non-absorbable patch (Dacron). They were divided in to two groups, GI (10 animals with omentopexy and repair) and GII (10 animals with repair, without omentopexy). On the 60 ^th day, animals were re-operated. In each case, adhesion band formation and its severity were recorded. Results: The difference between the incidence of adhesion band formation among the two group was statistically significant (P = 0.019).The majority of rabbits in GII (60%) had substantial adhesion bands (Grade >2 or severe score), whereas, in GI, none of rabbits had substantial adhesion bands (P = 0.019). Conclusion: Our study showed that the use of omentopexy as a cover in repair of diaphragmatic defect is versatile technique with a good success for decreasing of adhesion band formations at short-term follow-up.

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Background: The aetiology of hypospadias is largely uncharacterized. Some of the researchers have advocated that activating transcription factor 3 (ATF3), an oestrogen-responsive transcription factor, is up-regulated in patients with hypospadias. The purpose is to evaluate the universality of this fact; we studied the expression of ATF3 protein in prepuce tissue obtained from hypospadias and phimosis patients living in metropolitan Tokyo. Materials and Methods: Prepuce tissue was obtained from outer foreskin at the time of surgery, quickly prepared for paraffin-embedded sectioning and stained immunohistochemically for ATF3. Two researchers blindly evaluated immunoreactivity and scored it semi-quantitatively as nil = 0, weak = 1, or strong = 2, to give a final staining intensity score (SIS). Subjects were 18 hypospadias patients and 17 phimosis patients (as controls) who had surgery between January, 2009 and March, 2010. Results: All subjects lived in metropolitan Tokyo, Japan. Mean ages at surgery were 2.9 ± 1.0 and 3.9 ± 2.4 years, respectively (P > 0.05). SIS was not statistically different between hypospadias patients (1.4 ± 0.5) and controls (1.5 ± 0.5), (P > 0.05). Conclusions: Our data suggest that ATF3 is not highly associated with hypospadias in metropolitan Tokyo. Differences in ethnicity might have influenced our results.

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Lower pole heminephroureterectomy is a common paediatric urology procedure with few reported complications. We report a case of possible vascular ischemic injury to the normal remaining ureter following a lower pole heminephroureterectomy, probably due to both ureters sharing a common blood supply. Extra caution in such procedures is therefore warranted.

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