Login to Access Video or Poster Abstract: MP61-17
Sources of Funding: None

Introduction

The majority of congenital megaureters who present with prenatal dilation are managed conservatively by periodic monitoring with or without antibacterial prophylaxis. In some cases of break through infections, renal function deterioration and/or worsening of the dilation surgical intervention is contemplated. Surgery ranges from temporary stenting, refluxing re-implantation to cutaneous ureterostomy. Herein is a report on the results of the split-cuff nipple technique uretero-neocystotomy in the infantile small capacity bladder

Methods

Between 1996 and 2015 seventeen infants (12 males and 5 females) with 21 megaureters presented with breakthrough pyelonephritis(9), and worsening hydroureternephrosis (8). the ages varied between 14-34 weeks at the time of surgery. The ureteral diameter on ultrasonography was 12-30 mm(mean 16 mm). All underwent excision of the distal narrow ureteral segment and non-tapered transvesical reimplantation by a combination of a short submucosal tunnel (1-2 cm)and creation of a splt-cuff nipple ureteral orifice. 16/21 ureters were stented and the stents were removed 4-6 weeks postoperatvely. Follow up studies with ultrasonography(US)at 1,3,6 and 12 months and voiding cystouretherography (VCUG) were performed in all children at 4-6 months post surgery.

Results

Renal dilation improved in 15, resolved in5 and unchanged in 1 renal unit. The VCUG showed no vsicoureteral reflux in 19/21 (90%), Grade III and Grade I reflux in two ureters. Postoperative urinary infection occurred in 2 children.

Conclusions

In 1969 Lyon et al. suggested that the shape of the ureteral orifice played an important role in reflux prevention. In a parametric simulation model Villanueva et al studied the mechanics of the ureterovesical valve and challenged the time honored Paquin length/diameter rule of 5/1.Their model suggested that the shape of the ureteral orifice making it protrude into the bladder like a volcano or creating a nipple contributed to an efficient antireflux mechanism._x000D_ The simple split cuff nipple technique without ureteral tapering combined with a modest submucosal tunneling was highly successful for the management of dilated ureters and small capacity bladders when there is a limited space for conventional tapered long tunnel ureteroneocystotomy.

Funding

None