title: Inverted ureteral nipple as antireflux technique in surgical management of bilharzial ureteral strictures.
abstract: OBJECTIVE
  To present our initial clinical experience with the technique of inverted nipple ureteroneocystostomy in patients with dilated bilharzial ureters.
  
  
  METHODS
  A total of 36 patients with obstructed dilated bilharzial ureters (56 ureters) underwent inverted nipple ureteroneocystotomy after resection of the obstructed segment. Postoperatively, the patients were invited for follow-up at 3 and 6 months and yearly thereafter. At the first follow-up, urinalysis and culture examinations, serum creatinine measurement, ultrasonography, intravenous urography, or computed tomography, and voiding cystourethrography were performed. The mean follow-up was 32 months (range 16-52).
  
  
  RESULTS
  Symptomatic and radiologic improvement occurred in all patients, except for 2, and was sustained in all cases throughout the follow-up period. No reflux was demonstrated on static or voiding cystography in any patients. Recurrent postoperative hydronephrosis occurred in 2 reimplants (3.5%) owing to obstruction at the ureterovesical anastomosis. An episode of acute pyelonephritis requiring hospitalization and treatment with intravenous antibiotics occurred in 1 patient within the fist 6 months postoperatively. Mild reflux was subsequently demonstrated on voiding cystography.
  
  
  CONCLUSIONS
  The new technique of inverted nipple ureteroneocystostomy is suitable for reimplantation of dilated bilharzial ureters. Additional studies with a larger number of patients and longer follow-up are necessary to confirm these results.
authors.affiliation: Cairo University, As-Salam International Hospital, Cairo, Egypt. ashrafaboelela@yahoo.co.uk
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abou-Elela
authors.forename: Mohamed
authors.initials: M
authors.lastname: Torky
authors.forename: Essam
authors.initials: E
authors.lastname: Salah
authors.forename: Ahmad
authors.initials: A
authors.lastname: Morsy
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elsherbiny
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003558:Cystoscopy; D053715:Cystotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000209:etiology; D011704:Pyelonephritis / Q000209:etiology; D011859:Radiography; D012008:Recurrence; D012092:Replantation / Q000379:methods*; D012553:Schistosomiasis haematobia / Q000150:complications*; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*