The ureter as a pedicle for construction of a ureteral urethra: the double tunnel.
OBJECTIVE
Clean intermittent self-catheterization has been shown to be an effective method for the prevention of upper tract urinary disease in patients who are unable to void efficiently. When the urethra is not available for catheterization surgeons can construct a catheterizable channel from the appendix or retubularized bowel. However, for patients without an appendix and limited bowel segments we have reimplanted the ureter to prevent reflux and tunneled the distal portion of the same ureter to construct a catheterizable stoma, the "double tunnel."


METHODS
We retrospectively reviewed our 10-year experience with the double tunnel ureteral pedicle. A total of 10 patients (8 girls and 2 boys) were included in this study. The left ureter was used in 7 cases and the right ureter was used in 3. Mean followup for these patients was 4.1 years, with a range of 0.5 to 8.5 years. Outcome measures included intraoperative complications, reoperation rates, postoperative complications and upper urinary tract deterioration.


RESULTS
There were no intraoperative complications. Furthermore, there were no cases of stomal stenosis or strictures that required reoperation or excision of the ureteral pedicle in the followup period. In our cohort the renal function associated with the ipsilateral double tunnel ureteral pedicle remained stable or improved. All patients reported that their catheterizable stoma is still functional.


CONCLUSIONS
The double tunnel ureteral pedicle provides another option in the urological armamentarium when there are minimal resources with which to construct a catheterizable stoma.
Division of Pediatric Urology, Children's Hospital and Regional Medical Center, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Waldo C
WC
Feng
Pasquale
P
Casale
Richard W
RW
Grady
Byron D
BD
Joyner
Michael E
ME
Mitchell
D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014513:Ureter / Q000601:surgery*; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization; D014547:Urinary Diversion / Q000379:methods*