TITLE:
The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study
AUTHORS:
Abdullah Demirtas, Nurettin Sahin, Emre Can Akinsal, Mehmet Ali Ergul, Mehmet Caniklioglu, Oguz Ekmekcioglu, Atila Tatlisen
KEYWORDS:
Megaureter; Nipple; Technique; Ureter; Vesicoureteral Reflux
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.4,
July
22,
2013
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 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.