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A new surgical technique: ureterocystoplasty with a vascular pedicled ureteral segment in a single system megaureter
Özkan Herek, Nergül Çördük
Pamukkale University Faculty of Medicine Department of Pediatric Surgery, Denizli
3-day-old baby girl. She was referred to the neonatal unit from an external center with a diagnosis of renal failure. Emergency ultrasonographic examination revealed multicystic dysplastic kidney on the right and hydroureteronephrosis on the left. Bladder was very small. A left percutaneous nephrostomy catheter was placed. Creatinine level decreased to 0.35-0.52 mgr/dl in the patient by nephrostomy. Left ureterocutaneostomy was performed at the 3rd month of age. Although the bladder was exercised with regular daily bladder flushes to increase the bladder volume in the patient , no improvement was achieved. Antireflux operation was planned after bladder capacity increase by anastamosis of the ureter to the bladder.
Surgical Technique: For this purpose, the bladder was explored by Phannensteil incision. The ureter was freed from the left ureterocutaneostomy area. However, when the anatomical structure of the ureter was examined in detail, it was seen that the artery structure leading to the tip and the returning vein structure were very suitable for flap preparation from the tip. The vascular structure of the 5-6 cm ureter at the tip was preserved and a vascular ureter flap was created by separating it from the dilated ureter. The ureter with normal circulation was opened and a detubularized ureter segment was created. Then, the bladder was opened on the midline and the ureter was sutured to the bladder and ureterocystoplasty was performed. Then, dilated ureter was tapering by preserving the vascular pedicle. Ureteroneocystostomy was performed by extravesical approach. The 8 Fr feeding tube catheter placed in the ureter was withdrawn 15 days postop. No postop problem was experienced.
Conclusion: In the follow-up, it was found that the frequency of voiding gradually decreased and urine retention was comfortable for at least 4 hours. We concluded that ureterocystoplasty with this technique in appropriate ureters can be performed.