Double-nippled ureteroneocystostomy: a novel surgical technique in the management of the obstructed dilated ureter

Abstract

Objective: To present the outcome of double-nippled ureteroneocystostomy as a novel technique in the treatment of the dilated obstructed distal ureter. Patients and Methods: The technique was performed in 55 patients with lower ureteric stricture. The lowest segment of the dilated obstructed ureter is transected and passed through the bladder dome for ureterovesical implantation. The distal 3 cm is folded twice like a sleeve to fashion a double-nippled valve. Evaluation of the appearance and function of the ureter and ipsilateral renal function was done by laboratory, imaging and endoscopic studies at 3, 6 and 12 months following surgery, then annually. Results: Functional and morphological improvement was observed in 80% of the cases. Imaging and endoscopic verification of the valve stability and ipsilateral renal unit status, integrity and patency were confirmed in all patients but two (3.6%) who developed grade 2 vesico-ureteric reflux. Conclusion: Double-nippled ureteroneocystostomy is a safe and efficient surgical modality for the management of the dilated ureter due to bilharzial stricture.