Ureteral clipping for managing persistent urinary dribbling caused by ectopic ureters associated with non-functioning renal moieties in girls with complex duplex kidneys: a narrative review of the literature

Abstract

Background and Objective: Persistent urinary dribbling in girls with duplex renal systems and ectopic ureters originating from poorly functioning renal moieties represents a complex clinical problem in pediatric urology. The incontinence associated with these anomalies is socially distressing and often refractory to conservative management. Traditional surgical options, including upper pole heminephrectomy or ureteroureterostomy, are effective but may be associated with significant operative morbidity, particularly when renal function is negligible and surgical access is challenging. In recent years, minimally invasive ureteral ligation—either laparoscopic or via open mini-incision—has emerged as a promising, low-risk alternative to excise or disconnect the ectopic ureter. This review article aims to critically evaluate the safety, efficacy, and clinical utility of ureteral ligation in this subset of pediatric patients. Methods: A comprehensive literature search was conducted using PubMed and Web of Science through May 2024. Keywords included “ureteral clipping”, “ureteral ligation”, “ectopic ureter”, and “paediatric urinary incontinence”. Only English-language studies involving human pediatric populations were considered. Exclusion criteria included duplicate publications, animal studies, and articles that did not report clinical outcomes. Two independent reviewers performed data extraction and synthesis, focusing on postoperative continence, complications, renal outcomes, and procedural details. Key Content and Findings: Ureteral ligation was consistently associated with resolution or significant improvement of urinary incontinence in girls with ectopic ureters and non-functional upper moieties. The procedure appears to be technically straightforward, with minimal operative time and negligible intraoperative blood loss. Complication rates were low, and only one case of subsequent symptomatic infection or functional loss in the remaining renal moiety were reported. However, available data derive predominantly from small, retrospective, single-center series, with limited follow-up durations and the absence of control groups. Conclusions: Minimally invasive ureteral ligation represents a viable and effective surgical option for selected patients with ectopic ureters draining poorly functioning renal segments. Larger, multicenter prospective studies are warranted to confirm its long-term efficacy and establish clear clinical guidelines for its broader adoption.