Surgical treatment of megaureters using detrusor tunneling extravesical ureteroneocystostomy

From 1987 to 1992, 128 predominantly male patients 15 days to 19 years old (mean age 22 months) with a total of 167 megaureters underwent surgery for obstruction and/or reflux and symptomatic recurrent urinary infections. The technique consists of creating 2 holes through a muscle up to the mucosa by the detrusor splitting maneuver on the lateral bladder wall. Between the 2 holes a submucosal tunnel is created without detrusor resection. The megaureters are inserted into the tunnel and an anastomosis is made between the ureter and bladder mucosa. In cases of double megaureters 2 separate tunnels may be created. Regardless of the size, the megaureters can be inserted into the tunnel without any modeling. There are no problems with a wide megaureter since it spontaneously folds within the tunnel. However, the ureter must be maximally shortened and straightened to enable better urine flow, despite poor propulsive capacity of megaureters. Followup ranges from 3 months to 5 years (mean 2.5 years). Complications include 2 cases of stenosis and 3 of reflux recurrence. The method is safe with minimal surgical trauma. It is particularly applicable in newborns, infants and patients with neurogenic bladder.