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 comm on 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 nonfun ctional kidney to augment the bladder.(6) Only urothelium contacts uri ne and, thus, most of the complications of enteric augmentation are ob viated. A comparative analysis of ureterocystoplasty versus ileocystop lasty has shown that ureteral augmentation has equal efficacy in creat ing a high volume, low pressure storage bladder.(7) We initially descr ibed 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 pe lvic patch was carried by branches of the renal, gonadal and iliac ves sels. We report 2 cases of ureterocystoplasty using megaureters that h ad been previously operated on so that the distal ureteral blood suppl y was disrupted. Postoperative urodynamics are excellent in both cases . Successful ureterocystoplasty in these 2 patients who underwent prev ious ureteral surgery demonstrates the importance of the proximal bloo d supply for the ureteral/renal pelvic patch. Thus, previous distal ur eteral surgery is not a contraindication to ureterocystoplasty if the renal and gonadal vessels are preserved.