A modified technique of ureteroplasty for megaureter in children

Francisco Ossandon, Maria Victoria Romanini, Michele Torre

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Excisional ureteroplasty carries the risks of jeopardizing the ureteral vasculature and leakage from the suture. The folding techniques are theoretically less prone to these risks, although they have other disadvantages due to the bulky ureter. According to the literature, these 2 approaches have similar complication rates of 4% to 25%, to include stenosis, reflux and leakage. We introduce a modified ureteroplasty technique with the aim of ensuring effective reduction of the ureteral diameter with minor risks to the vasculature. Materials and Methods: A total of 42 consecutive patients underwent ureteroplasty and reimplantation (Cohen 16, Politano-Leadbetter 3, psoas hitch 23) between 1994 and 2004, and were followed for 1 to 9 years. The ureter was opened longitudinally on its less vascularized area. Two parallel longitudinal incisions were made from the luminal side up to the musculature layer, leaving the adventitia untouched. The mucosal aspects lateral to these lines were discarded. The inner layer was closed with a running suture. The adventitial layer was closed with single stitches. Results: No leakage, stenosis or reflux was observed. In 3 ureters persistent dilatation was observed, without obstruction or reflux. Conclusions: Our modification combines some principles of the 2 classic techniques, with the purpose of decreasing the risks and disadvantages of both. We believe that our approach affords better preservation of the ureteral vasculature because the adventitia is preserved untouched, as well as effective caliber reduction so that the bulking problem is avoided. In addition, the technique is associated with a minor risk of leakage. Our results show that this approach is a valid option for megaureter correction in children.

Original languageEnglish
Pages (from-to)1417-1420
Number of pages4
JournalJournal of Urology
Volume174
Issue number4 I
DOIs
Publication statusPublished - Oct 2005

Keywords

  • Reconstructive surgical procedures
  • Reimplantation
  • Ureter
  • Ureteral obstruction
  • Urologic surgical procedures

ASJC Scopus subject areas

  • Urology

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