Back
 OJU  Vol.3 No.4 , August 2013
The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study
Abstract: Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.
Cite this paper: A. Demirtas, N. Sahin, E. Akinsal, M. Ergul, M. Caniklioglu, O. Ekmekcioglu and A. Tatlisen, "The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study," Open Journal of Urology, Vol. 3 No. 4, 2013, pp. 179-184. doi: 10.4236/oju.2013.34033.
References

[1]   L. R. King, “Megaloureter: Definition, Diagnosis and Management,” The Journal of Urology, Vol. 123, No. 2, 1980, pp. 222-223.

[2]   A. Atala, “Vesicoureteral Reflux and Megaureter,” In: P. C. Walsh, Ed., Campbell’s Urology, W. B. Saunders Co., Philadelphia, 2002, pp. 2059-2116.

[3]   H. H. Bakker, R. J. Scholtmeijer and P. J. Klopper, “Comparison of 2 Different Tapering Techniques in Megaureters,” The Journal of Urology, Vol. 140, No. 5, 1988, pp. 1237-1239.

[4]   R. M. Ehrlich, “The Ureteral Folding Technique for Megaureter Surgery,” The Journal of Urology, Vol. 134, No. 4, 1985, pp. 668-670.

[5]   R. F. Mattingly, “Operative Injuries of the Ureter,” In: R. W. Te Linde, Ed., Te Linde’s Operative Gynecology, JB Lippincott, Philedelphia, 1995, p. 325.

[6]   A. Liapis, P. Bakas, V. Giannopoulos, et al., “Ureteral Injuries during Gynecological Surgery,” International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 12, No. 6, 2001, pp. 391-393. doi:10.1007/PL00004045

[7]   M. Rafique and M. H. Arif, “Management of Iatrogenic Ureteric Injuries Associated with Gynecological Surgery,” International Urology and Nephrology, Vol. 34, No. 1, 2002, pp. 31-35. doi:10.1023/A:1021320409583

[8]   R. H. Whitaker, “The Whitaker Test,” The Urologic Clinics of North America, Vol. 6, No. 3, 1979, pp. 529-539.

[9]   A. Tatlisen and O. Ekmekcioglu, “Direct Nipple Ureteroneocystostomy in Adults with Primary Obstructed Megaureter,” The Journal of Urology, Vol. 173, No. 3, 2005, pp. 877-880. doi:10.1097/01.ju.0000152533.93716.3c

[10]   N. Roberts, M. J. Puddephat and V. McNulty, “The Benefit of Stereology for Quantitative Radiology,” The British Journal of Radiology, Vol. 73, No. 871, 2000, pp. 679-697.

[11]   J. R. Nyengaard, “Stereologic Methods and Their Application in Kidney Research,” Journal of the American Society of Nephrology, Vol. 10, No, 5, 1999, pp. 1100-1123.

[12]   K. T. Bae, P. K. Commean and J. Lee, “Volumetric Measurement of Renal Cysts and Parenchyma Using MRI: Phantoms and Patients with Polycystic Kidney Disease,” Journal of Computer Assisted Tomography, Vol. 24, No. 4, 2000, pp. 614-619. doi:10.1097/00004728-200007000-00019

[13]   S. Al-Shukri and M. H. Alwan, “Bilharzial Strictures of the Lower Third of the Ureter: A Critical Review of 560 Strictures,” British Journal of Urology, Vol. 55, No. 5, 1983, pp. 477-482. doi:10.1111/j.1464-410X.1983.tb03352.x

[14]   W. H. Hendren, “Complications of Megaureter Repair in Children,” The Journal of Urology, Vol. 113, No. 2, 1975, pp. 238-254.

[15]   S. Perovic, “Surgical Treatment of Megaureters Using Detrusor Tunneling Extravesical Ureteroneocystostomy,” The Journal of Urology, Vol. 152, No. 2, 1994, pp. 622-625.

[16]   J. E. Hill, A. I. Dodson. and J. W. Hooper, “Experimental Ureteroneocystostomy Using Nipple Anastomosis Technique,” The Journal of Urology, Vol. 74, No. 5, 1955, pp. 596-599.

[17]   A. I. Sagalowsky, “Early Results with Split-Cuff Nipple Ureteral Reimplants in Urinary Diversion,” The Journal of Urology, Vol. 154, No. 6, 1995, pp. 2028-2031. doi:10.1016/S0022-5347(01)66682-5

[18]   R. T. Warwick and M. H. Ashken, “The Functional Results of Partial, Subtotal and Total Cystoplasty with Special Reference to Ureterocaecocystoplasty, Selective Sphincterotomy and Cystocystoplasty,” British Journal of Urology, Vol. 39, No. 1, 1967, pp. 3-12. doi:10.1111/j.1464-410X.1967.tb11774.x

[19]   B. R. Lee, R. I. Silver, A. W. Partin, et al., “A Quantitative Histologic Analysis of Collagen Subtypes: The Primary Obstructed and Refluxing Megaureter of Childhood,” Urology, Vol. 51, No. 5, 1998, pp. 820-823. doi:10.1016/S0090-4295(98)00013-2

[20]   P. G. Ransley, “Vesicoureteric Reflux: Continuing Surgical Dilemma,” Urology, Vol. 12, No. 3, 1978, pp. 246-255. doi:10.1016/0090-4295(78)90387-4

[21]   J. W. Duckett, R. D. Walker and R. Weiss, “Surgical Results: International Reflux Study in Children-United States Branch,” The Journal of Urology, Vol. 148, No. 5, 1992, pp. 1674-1675.

[22]   International Reflux Study Committee, “Medical versus Surgical Treatment of Primary Vesicoureteral Reflux: Report of the International Reflux Study Committee,” Pediatrics, Vol. 67, No. 3, 1981, pp. 392-400.

[23]   C. A. Peters, J. Mandell, R. L. Lebowitz, et al., “Congenital Obstructed Megaureters in Early Infancy: Diagnosis and Treatment,” The Journal of Urology, Vol. 142, No. 2, 1989, pp. 641-645.

[24]   D. Kitchens, E. Minevich, W. DeFoor, et al., “Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer to Correct Vesicoureteral Reflux Following Failed Ureteroneocystostomy,” The Journal of Urology, Vol. 176, No. 4, 2006, pp. 1861-1863. doi:10.1016/S0022-5347(06)00611-2

[25]   E. W. Lupton, D. Holden, N. J. George, et al., “Pressure Changes in the Dilated Upper Urinary Tract on Perfusion at Varying Flow Rates,” British Journal of Urology, Vol. 57, No. 6, 1985, pp. 622-624. doi:10.1111/j.1464-410X.1985.tb07019.x

 
 
Top