Inverted ureteral nipple as antireflux technique in surgical management of bilharzial ureteral strictures

To present our initial clinical experience with the technique of inverted nipple ureteroneocystostomy in patients with dilated bilharzial ureters.

A total of 36 patients with obstructed dilated bilharzial ureters (56 ureters) underwent inverted nipple ureteroneocystotomy after resection of the obstructed segment. Postoperatively, the patients were invited for follow-up at 3 and 6 months and yearly thereafter. At the first follow-up, urinalysis and culture examinations, serum creatinine measurement, ultrasonography, intravenous urography, or computed tomography, and voiding cystourethrography were performed. The mean follow-up was 32 months (range 16-52).

Symptomatic and radiologic improvement occurred in all patients, except for 2, and was sustained in all cases throughout the follow-up period. No reflux was demonstrated on static or voiding cystography in any patients. Recurrent postoperative hydronephrosis occurred in 2 reimplants (3.5%) owing to obstruction at the ureterovesical anastomosis. An episode of acute pyelonephritis requiring hospitalization and treatment with intravenous antibiotics occurred in 1 patient within the fist 6 months postoperatively. Mild reflux was subsequently demonstrated on voiding cystography.

The new technique of inverted nipple ureteroneocystostomy is suitable for reimplantation of dilated bilharzial ureters. Additional studies with a larger number of patients and longer follow-up are necessary to confirm these results.