Reimplantation of obstructive megaureters with and without tailoring

Ben‐Meir, David; McMullin, Neil; Kimber, Chris; Gibikote, Sridhar; Kongola, Kalumba; Hutson, John M.

doi:10.1016/j.jpurol.2005.05.010

Cited by 22 publications

(14 citation statements)

References 12 publications

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“…Surgery usually entails reimplanting the plicated or tapered ureter into the bladder. Plication usually results in a bulky ureter, whereas tapering can lead to anastomotic stricture . Furthermore, the thick non‐pliable bladder might encumber the reimplantation of the ureter, and increases the risk of postoperative ureteral stricture …”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, obstructed megaureters have been treated by tailoring and reimplantation of the ureters into the bladder . Ureteral reimplantation into the thickened trabeculated non‐compliant bladder with friable mucosa imposes technical difficulty and increases the risk of postoperative ureteral stricture .…”

Section: Introductionmentioning

confidence: 99%

“…Ureteral reimplantation into the thickened trabeculated non‐compliant bladder with friable mucosa imposes technical difficulty and increases the risk of postoperative ureteral stricture . Tailoring of megaureters might be complicated by stenosis at the ureterovesical anastomosis when excisional tapering is carried out, or excessive bulk of tissue when plicated . Likewise, ureterointestinal anastomosis using a non‐refluxing technique could result in higher rates of anastomotic stricture than the direct anastomosis …”

Section: Introductionmentioning

confidence: 99%

“…4 Traditionally, obstructed megaureters have been treated by tailoring and reimplantation of the ureters into the bladder. 5 Ureteral reimplantation into the thickened trabeculated non-compliant bladder with friable mucosa imposes technical difficulty and increases the risk of postoperative Original Article: Clinical Investigation ureteral stricture. 6 Tailoring of megaureters might be complicated by stenosis at the ureterovesical anastomosis when excisional tapering is carried out, or excessive bulk of tissue when plicated.…”

Section: Introductionmentioning

confidence: 99%

“…6 Tailoring of megaureters might be complicated by stenosis at the ureterovesical anastomosis when excisional tapering is carried out, or excessive bulk of tissue when plicated. 5 Likewise, ureterointestinal anastomosis using a nonrefluxing technique could result in higher rates of anastomotic stricture than the direct anastomosis. 7 In 1989, Studer et al reported their first 3 years of experience of orthotopic ileal neobladder replacement, with an ileal loop chimney for direct ureteroileal anastomosis to prevent vesicoureteral reflux.…”

Section: Introductionmentioning

confidence: 99%

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Novel augmentation ileocystoplasty technique to manage non‐compliant bladders in the presence of obstructed megaureters: The “fez procedure”

et al. 2015

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Abbreviations & Acronyms 99mTc-DTPA = technetium 99m-diethylene triamine pentaacetic acid CIC = clean intermittent catheterization GFR = glomerular filtration rate UTIs = urinary tract infections VCUG = voiding cystourethrography VUR = vesicoureteral reflux Objectives: To show the efficacy and safety of a novel modification of Studer's neobladder, herein defined as the "fez procedure." Methods: The medical records of 21 children (mean age 9.4 ± 1.3 years) who underwent the "fez procedure" at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, to manage refractory poorly-compliant bladders and concomitantly obstructed megaureters were retrospectively reviewed. The patients had been previously managed by either preliminary cutaneous ureterostomy (17 patients) or temporary nephrostomy (four patients) to improve and stabilize the renal functions. The "fez procedure" entailed augmentation ileocystoplasty and the use of an afferent tubularized ileal loop for direct ureteroileal anastomosis. The augmented bladder together with the tubularized loop were fashioned as a "fez" with its tassel. The outcome measures were changes in cystometric capacity, bladder compliance, glomerular filtration rate, serum creatinine, technetium 99m-diethylene triamine pentaacetic acid diuretic renography (T1/2), ureteral diameter, vesicoureteral reflux, febrile urinary tract infections, continence and complications. Results: The mean study follow-up period was 52.5 ± 12.8 months. Means of changes of cystometric capacity (273.2 ± 60.9 mL) and bladder compliance (15.6 ± 4.2 mL/cm H 2 O) were significant (P < 0.0001). Resolution of ureteral obstruction was documented with improved T1/2 and ureteral diameter (P < 0.0001, each) of all patients. The initially improved renal functions after ureterostomies or nephrostomies were maintained after "fez surgery," with non-significant changes in the improved glomerular filtration rate (P = 0.22) and serum creatinine (P = 0.18). None of the patients experienced ureteral restenosis, vesicoureteral reflux, febrile urinary tract infections, incontinence or significant complications. Conclusions: The "fez procedure" represents a versatile and successful surgical option for these selected patients, as it offers improved bladder capacity/compliance, resolution of ureteral obstruction and vesicoureteral reflux, preservation of the renal function, control of urinary tract infections and urinary continence, and acceptable morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Novel augmentation ileocystoplasty technique to manage non‐compliant bladders in the presence of obstructed megaureters: The “fez procedure”

et al. 2015

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Partial excisional tapering: Report of initial four cases of a novel modification of ureteroplasty for megaureter

Taguchi,

Kanematsu,

Yamamoto

2023

IJU Case Reports

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IntroductionWe report our initial experience with a novel ureteroplasty technique that combines the advantages of excisional tapering and folding.Methods and casesFollowing dissection of the megaureter, the distal ureteral end was transected at a point with an appropriate caliber to create a neo‐orifice, which was left intact. Only the proximally redundant part of the ureter was excised and closed over a 10F catheter, following which the ureter was anastomosed to the bladder with an indwelling ureteral stent. This procedure was performed in four pediatric patients. Case 1 involved a 6‐year‐old girl with continuous urinary incontinence due to ureteral ectopia in a duplex system. Cases 2 and 3 involved infants with refluxing megaureter. Case 4 involved a 9‐year‐old boy with a ureteral stone impacted in a megaureter. All four patients achieved successful outcomes without ureteral obstruction.ConclusionThis ureteroplasty technique is a promising alternative in specific patients.

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Advancements in Surgical Management of Megaureters

Boswell

2024

Curr Urol Rep

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Purpose of Review To review and describe the recent evolution of surgery for the various types of pediatric megaureter. Recent Findings Megaureter management first relies on determining the underlying cause, whether by obstruction, reflux, or a combination, and then setting appropriate surgical indications because many cases do not require surgery as shown by observation studies. Endoscopic balloon dilation has been on the rise as a major treatment option for obstructive megaureter, while refluxing megaureters can also be treated by laparoscopic and robotic techniques, whether extravesically or transvesicoscopically. During ureteral reimplantation, tapering is sometimes necessary to address the enlarged ureter, but there are also considerations for not tapering or for tapering alternatives. Summary Endoscopic and minimally invasive surgeries for megaureter have been the predominant focus of recent megaureter literature. These techniques still need collaborative prospective studies to better define which surgeries are best for patients needing megaureter interventions.

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Reimplantation of obstructive megaureters with and without tailoring

Cited by 22 publications

References 12 publications

Novel augmentation ileocystoplasty technique to manage non‐compliant bladders in the presence of obstructed megaureters: The “fez procedure”

Novel augmentation ileocystoplasty technique to manage non‐compliant bladders in the presence of obstructed megaureters: The “fez procedure”

Partial excisional tapering: Report of initial four cases of a novel modification of ureteroplasty for megaureter

Advancements in Surgical Management of Megaureters

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