Abstract
In the surgical procedure of uretero-vesical anastomosis, submucosal tunnel method is widely used to prevent vesico-ureteral reflux (VUR). For the reimplantation of the dilated ureter in children, several techniques of ureteroplasty have been proposed to gain the appro-priate ureteral caliber to submucosal tunnel length ratio. The ureteroplasty which have been popularized for megaureter surgery is the resectional tailoring (tapering), in which a lateral ureteral strip is excised for a various length. There is always the risk to damage the ureteral blood supply with subsequent ischemic stenosis. To avoid this complication, we adopted, in recent 4 years, 2 new techniques of ureteroplasty without resecting the ureteral wall. One is plication technique, in which excess ureteral wall is inverted in the lumen of the ureter. Another is folding technique involving a running stitch to exclude a portion of ureteral lumen which is then folded around the ureter. The use of non-resecting technique is possible for any type of dilated ureter except for extremely widened and thickened ureteral wall. In the past 13 years, ureteroplasty for dilated ureter has been used on 33 ureters in 32 children. Of these ureters, 15 had primary obstruction, 8 had primary VUR, 6 had ectopic orifice and 4 had ureterocele. The postoperative evaluation was made on 32 ureters in 31 children, and an over-all success rate was 84 per cent. Of the 17 ureters operated on through tapering method, success rate was 71%. All ureters with non-resecting technique achieved satisfactory result. Analysis of the cases with unsatisfying result indicated the importance to differentiate the causes of ureteral dilatation. We emphasize that the secondary type of dilated ureter and nonrefluxing, nonobstructed megaureter must be excluded from the primary recon-structive surgery.
