URETEROCYSTOPLASTY - IMPORTANCE OF THE PROXIMAL BLOOD-SUPPLY

Bladder augmentation is being performed with greater frequency for the management of the high pressure, poorly compliant bladder. Presently, incorporation of an enteric segment into the bladder is the most common method of augmentation. However, the presence of a gastrointestinal segment in the bladder has several well described complications.(1-5) We previously reported using the massively dilated ureter of a nonfunctional kidney to augment the bladder.(6) Only urothelium contacts urine and, thus, most of the complications of enteric augmentation are obviated. A comparative analysis of ureterocystoplasty versus ileocystoplasty has shown that ureteral augmentation has equal efficacy in creating a high volume, low pressure storage bladder.(7) We initially described using a patch consisting of meter and renal pelvis in continuity.(6) None of our patients had undergone any previous operations on the ipsilateral kidney or meter. The blood supply of the ureteral/renal pelvic patch was carried by branches of the renal, gonadal and iliac vessels. We report 2 cases of ureterocystoplasty using megaureters that had been previously operated on so that the distal ureteral blood supply was disrupted. Postoperative urodynamics are excellent in both cases. Successful ureterocystoplasty in these 2 patients who underwent previous ureteral surgery demonstrates the importance of the proximal blood supply for the ureteral/renal pelvic patch. Thus, previous distal ureteral surgery is not a contraindication to ureterocystoplasty if the renal and gonadal vessels are preserved.