[Repair of megaureter by tailoring in two layers while preserving vascular supply (author's transl)]

Since 1976 we tapered extremely wide obstructive or refluxive megaureters with partial fibrosis by this new technique, sometimes over 2/3 of length with ureterolysis in the upper segment. In these cases, preservation of the mesoureteric vascular supply is important in addition to the regular intramural nutrition. The mesoureteric arteries and veins spread into the adventitia and turn around in curves like a network. Exactly linear resection would cause damage. Therefore, we remove the adventitia from the lateral shape, resect beneath the abundant strip of muscularis with mucosa, trimming the megaureter downwards to a diameter of 7 to 4 mm, close the inner layer with running and interlocking 5-0 chromic suture over a splint and then readapt the adventitia. The advantages are: better arterial vascular supply, minimal thrombosis, no necrosis and no urinary leakage, less scarring and, therefore, good peristalsis.