High urinary diversion as intermediate treatment of megaureter: 15 years of experience

Purpose: The ureteropyelocutaneostomy has the advantage of safe decompressi on of the obstructed upper urinary tract, as prerequisite for recovery of r enal function in obstructed megaureters. Our own long term results are pres ented herein. Materials and Methods: From 1984 to 1999 a high loop ureterocutaneostomy wa s performed in 44 and a pyelocutaneostomy in 5 children. Patient age ranged from 5 days to 2 years. Indications were primacy obstructive of secondary megaureters with extensive dilatation of the upper urinary tract, urinary t ract infection or decreased renal function. After surgical decompression of the obstructed urinary tract, treatment of urinary infection and improveme nt of renal function, a urinary undiversion was performed 6-36 months later . Reconstruction with closure of the cutaneous fistula and psoas hitch-uret erocystoneostomy was usually done simultaneously. Results: Postoperative renal function increased in 40 patients (81.6%) and stabilized in 6 (12.3%). 2 children with renal function decrease (4.1%) req uired a secondary nephrectomy. One additional patient (2%) developed: a ste notic cutaneous stoma with deterioration of renal function resulting in nep hrectomy. Conclusions: The advantages of loop ureterocutaneostomy (safe decompression , avoidance of a dry lower urinary tract) predominate over the disadvantage s (proximal, urodynamically insignificant ureter kinking, sometimes difficu lt closure of the urinary fistula). In cases with a very dilated renal pelv is,, pyelocutaneostomy should be the preferred approach, because urinary di version and subsequent undiversion are easier and the ureter remains untouc hed.