Revascularized Pyelo-Uretero-Cystoplasty in Patients with Chronic Bladder Outlet Obstruction Due to Ectopic Ureterocele: A Safe Surgical Technique with Superior Continence Outcomes

Abstract

Purpose

To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele.

Methods

Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for ‘jet/turbulent’ occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up.

Results

Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H₂O to 29 ml/cm H₂O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group.

Conclusion

Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.

Keywords:

• Reconstructive surgical procedures
• ureterocele
• urinary reservoirs
• urodynamic
• blood supply

Acknowledgement

The authors wish to thank Mrs. Semira Farrokhi for drawing the figures and we also express our gratitude for the specific help of Dr. Mohammad Reza Ostovaneh, Dr. Yasin Farrokhi-Khajeh-Pasha, and Dr. Behtash Ghazi Nezami in drafting the first edition of the article and assistance in analysis of the data.

Consent for publication

Consent for publication have been obtained from their parent or legal guardian.

Disclosure statement

No potential conflict of interest was reported by the author(s).