Reimplantation of obstructive megaureters with and without tailoring

Abstract 

Objectives

Reimplantation of megaureters may be complicated by excessive bulk of tissue when plicated, or stenosis at the anastomosis site when excisional tapering is performed. Some urologists in our institution reimplant megaureters without tailoring, while others routinely tailor megaureters. Aiming to compare success rates, we report our experience in reimplanting obstructive megaureters with and without tailoring.

Materials

The medical records of 30 boys and four girls with primary obstructive megaureters (a total of 38 ureters) were reviewed. Median age at operation was 18 months (range 1 month to 8 years). Of the ureters, 16/38 were tailored and 22/38 were reimplanted without tailoring.

Results

Preoperative mean diameter (per ultrasound) of the 16 tailored ureters was 16.1mm (range 10–26mm). Postoperative ultrasound showed resolution of hydronephrosis in 3/16 (19%), an improvement in 11/16 (69%), and no change in the degree of hydronephrosis in 2/16 (13%). Preoperative mean diameter of the non-tailored ureters was 14mm (range 10–27mm), and postoperative ultrasound showed resolution of hydronephrosis in 11/22 (50%), an improvement in 10/22 (45%), and no change in the degree of hydronephrosis in 1/22 (5%). Of the tailored ureters, 1/16 needed re-operation because of anastomotic stricture, and one girl had recurrent urinary tract infections. Of the non-tailored ureters, four had recurrent infection, of whom one boy underwent redo reimplantation because of grade 2 vesicoureteric reflux.

Conclusion

In this series non-tailoring reimplantation was an equivalent option to tailoring in obstructive megaureters.

Keywords: Primary obstructive megaureter, Tapering, Plication, Non-tailoring