title: Results of tapered ureteral reimplantation for primary megaureter: extravesical versus intravesical approach.
abstract: OBJECTIVE
  Extravesical ureteroneocystostomy is an accepted technique for the surgical treatment of vesicoureteral reflux. However, many surgeons continue to use an intravesical technique when extensive ureteral tailoring is required in the case of primary megaureter. We present our experience and outcomes with these techniques.
  
  
  METHODS
  A retrospective cohort study was performed of all patients who underwent tapered ureteral reimplantation between 1990 and 2002. Patient demographics, surgical technique and outcomes were recorded. Patients with ureteral dilatation secondary to bladder or urethral pathology were excluded from study. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.
  
  
  RESULTS
  A total of 53 patients with 65 megaureters were identified. Mean patient age at surgery was 4.9 years and mean followup was 3.8 years. Primary obstructive megaureter was present in 31 renal units, while refluxing megaureter was present in 34. An excisional tapering technique was performed in all cases. An extravesical reimplantation was performed in 29 renal units and an intravesical reimplantation in 36. The success rate was 86% for intravesical and 76% for extravesical reimplantation. The success rate was 90% for obstructive megaureters and 74% for refluxing megaureters. Success rate for patients with voiding dysfunction was 93% with an intravesical approach but only 50% with an extravesical approach.
  
  
  CONCLUSIONS
  Extensive ureteral tailoring with an extravesical ureteral reimplantation may be performed safely and effectively for primary obstructive megaureter. Patients with voiding dysfunction or preoperative vesicoureteral reflux may benefit from an intravesical ureteral reimplantation.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. bob.defoor@cchmc.org
authors.forename: William
authors.initials: W
authors.lastname: DeFoor
authors.forename: Eugene
authors.initials: E
authors.lastname: Minevich
authors.forename: Pramod
authors.initials: P
authors.lastname: Reddy
authors.forename: Ethan
authors.initials: E
authors.lastname: Polsky
authors.forename: Andrew
authors.initials: A
authors.lastname: McGregor
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wacksman
authors.forename: Curtis
authors.initials: C
authors.lastname: Sheldon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods