title: Direct nipple ureteroneocystostomy in adults with primary obstructed megaureter.
abstract: OBJECTIVE
  We evaluated the results of direct nipple ureteroneocystostomy technique in adults with primary obstructed megaureter.
  
  
  METHODS
  Five patients with a mean age of 32.5 years had a total of 6 primary obstructed megaureters with complaints of flank pain. Two patients were female and 3 were male. In patient 1 disease was bilateral, in 3 it was on the right side and in 1 it was on the left side. In male patient 1 a thick walled right ureter could be directly inserted into the bladder without eversion or tapering. The left nipple was created with spatulation. In 2 cases the ureters were thin walled (2 mm or less) and the nipples were created without spatulation. In the other 2 cases the nipples were created following spatulation since the ureteral walls were thicker (2 to 3 mm).
  
  
  RESULTS
  Mean followup was 36 months. Flank pain complaints resolved in the postoperative period. Early postoperative Whitaker tests revealed nonobstructed renal units. At later followup visits excretory urograms and/or ultrasound showed partially resolved hydroureteronephrosis.
  
  
  CONCLUSIONS
  Ease of application, a high success rate and no need to taper or plicate the ureter, or prepare a submucosal tunnel might be the reasons to consider the direct nipple technique for megaureters of different etiologies.
authors.affiliation: Department of Urology, Erciyes University Medical Faculty, Kayseri, Turkey. atatlisen@erciyes.edu.tr
authors.forename: Atila
authors.initials: A
authors.lastname: Tatlişen
authors.forename: Oğuz
authors.initials: O
authors.lastname: Ekmekçioğlu
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*