title: Dismembered extravesical reimplantation of dilated upper pole ectopic ureters in duplex systems.
abstract: OBJECTIVE
  We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone.
  
  
  METHODS
  Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder. The distal stump was suture closed, while the proximal segment was mobilized, tapered as necessary, and reimplanted using an extravesical technique.
  
  
  RESULTS
  Twelve ectopic ureters were reimplanted. Median (range) patient age at surgery was 8 (3-48)months. Ureteral tapering was performed in 11 ureters, by infolding in 9 and using an excisional tailoring in the single case undergoing bilateral reimplantation. After a median (range) follow-up of 17 (6-50)months, all patients were asymptomatic. Eleven reimplanted ureters showed improving hydroureteronephrosis, no obstruction on diuretic scintigraphy, and no evidence of reflux on indirect radionuclide cystography. One reimplanted ureter developed worsening hydroureteronephrosis after excisional tailoring of the ureter and partial nephrectomy was performed.
  
  
  CONCLUSIONS
  Extravesical reimplantation of the upper pole ureter is an option in dilated upper pole ectopic ureters with good function. Separating the upper and lower pole ureters proximally to the bladder does not jeopardize the ureteral blood supply and allows leaving the lower pole ureter undisturbed. Excisional ureteral tailoring should be avoided.
authors: Section for Paediatric Urology, Urology Unit, University Hospital of Padova, Monoblocco Ospedaliero; Via Giustiniani, 2; 35128-Padua-Italy. marcocastagnetti@hotmail.com
authors: Marco
authors: M
authors: Castagnetti
authors: Raffaella
authors: R
authors: Canali
authors: Giuseppe
authors: G
authors: Mastrocinque
authors: Ciro
authors: C
authors: Esposito
authors: Waifro
authors: W
authors: Rigamonti
mesh_terms: D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012092:Replantation; D012189:Retrospective Studies; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods