title: The embedded nipple: An optimal technique for re-implantation of primary obstructed megaureter in children.
abstract: OBJECTIVE
  To present a novel ureteric re-implantation technique for primary obstructed megaureter (POM) that ensures success in the short- and long-term, as conventional techniques are not ideal for megaureters especially in children, with ureteric stenosis and reflux being common complications after re-implantation.
  
  
  METHODS
  Between 2009 and 2012, 22 paediatric patients with POM were enrolled. We performed a new technique for re-implantation of these ureters to ensure minimal incidence of ureteric strictures and easy subsequent endoscopic access. We performed follow-up voiding cystourethrography (VCUG) at 6 months postoperatively.
  
  
  RESULTS
  The cohort comprised 14 boys and eight girls, with a median age of 22 months. Six patients underwent bilateral re-implantation. The mean (range) duration of indwelling ureteric catheterisation was 7.8 (4-14) days. There were no complications in the perioperative and postoperative periods. There was no reflux on follow-up VCUG in any of the patients. One patient developed Grade I reflux after 1 year and presented with a urinary tract infection. Diagnostic cystoscopy was performed in 13 patients showing that the nipple was directed similarly to the native ureteric orifice.
  
  
  CONCLUSIONS
  The embedded-nipple technique for re-implantation of POM guarantees successful results and permits easy subsequent ureteroscopic access when needed.
authors: Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Tamer M
authors: TM
authors: Abou Youssif
authors: Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Ahmed
authors: A
authors: Fahmy
authors: Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Hazem
authors: H
authors: Rashad
authors: Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Mohammed Adel
authors: MA
authors: Atta
keywords: DRF, differential renal function; DTPA, diethylene-triamine-penta-acetic acid; HUN, hydroureteronephrosis; POM, primary obstructive megaureter; Primary obstructed megaureter; Reconstructive urology; US, ultrasonography/ultrasound; UTI, Urinary tract infection; Ureteric re-implantation; VCUG, voiding cystourethrography