Ureterocystoplasty: is it necessary to detubularize the distal ureter?

Abstract

The conventional technique for ureterocystoplasty includes complete mobilization and incision of the ureter. We describe a modified procedure in which the distal 3 cm. of ureter are left in place and intact. This modification has been used in our last 13 cases of ureterocystoplasty. The first 7 patients with followup of more than a year (mean 28 months) are included in this series, and 6 have undergone video urodynamic evaluation before and after reconstruction. Clinical results have been good. Four patients who have been toilet trained are continent. There have been no problems from stagnant urine in the intact ureter with only 1 case of pyelonephritis and no bladder calculi. Mean bladder capacity on cystometrogram has increased from 103 to 236 ml. after reconstruction and reached 137% of expected capacity for age and size (range 110 to 155%). No uninhibited contractions or problems with compliance have been noted. The distal ureter may be left intact for ureterocystoplasty to protect ureteral blood supply. This modified technique is sound from a physiological standpoint, technically easier and associated with good results.