Observations on persistently dilated ureter after posterior urethral valve ablation

The persistent ureteral dilatation frequently seen months or even years after posterior urethral valve ablation, continues to present a dilemma to the urologist. We have classified these dilated ureters into 3 types: (I) unobstructed with either an empty or filling bladder, (II) unobstructed with an empty bladder but obstructed with a filling bladder, and (III) obstructed with either an empty or filling bladder. The majority of ureters with persistent dilatation were found to be of the type II variety where appropriate treatment is not obvious. Classic ureteral tailoring and reimplantation offers little advantage since in such cases a narrower ureter is passed through a new hiatus in an otherwise unchanged bladder. When high renal pelvic pressures are found only with bladder filling, then consideration must be given to not only reconstructing the ureter but also to affecting the dynamics of the bladder and the large urinary output characteristically found in these patients.