title: Utilizing an Umbilical Ligament for Complex Ureteroneocystostomy.
abstract: BACKGROUND
  To overcome the tension of anastomosis between ureter and bladder for complex ureteroneocystostomy in children, we describe a novel technique utilizing an ipsilateral umbilical ligament (occluded umbilical artery) to fix the bladder.
  
  
  METHODS
  From July 1991 to December 2013, 18 patients (13 girls, 5 boys) underwent our technique for complex ureteroneocystostomy. Median age at surgery was 61 months. The main indications for surgery were ectopic ureter in 9 patients, primary obstructive megaureter in 3, and persistent vesicoureteral reflux after surgery in 2. The ipsilateral umbilical ligament was ligated. A new hiatus was created craniolateral to the original hiatus. The submucosal tunnel was created trans-trigonally. The umbilical ligament was sutured to the whole bladder muscle at the hiatus. Ureteroneocystostomy was then performed. Mean duration of postoperative follow-up was 62.6 months. Seventeen patients underwent unilateral ureteroneocystostomy with our technique. One patient underwent bilateral ureteroneocystostomy with our technique on one side. Vesicoureteral reflux was not shown in 92.3% of patients and no signs of obstruction developed in any patients. No complications were encountered with our procedure.
  
  
  CONCLUSIONS
  Utilizing an umbilical ligament for ureteroneocystostomy to fix the bladder is an excellent option when the distal ureter creates tension in uretero-bladder anastomosis. This method seems to be applicable in many cases of complex ureteroneocystostomy in children.
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Electronic address: f.matsui@mch.pref.osaka.jp.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Matsui
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Fumi
authors.initials: F
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yazawa
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Matsuyama
authors.affiliation: Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Ito
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008022:Ligaments / Q000637:transplantation*; D008297:Male; D012189:Retrospective Studies; D014469:Umbilical Arteries / Q000637:transplantation*; D014472:Umbilicus; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*