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Unlabelled: The tubularized-incised plate urethroplasty has traditionally been used in children for repairing hypospadias. As shown here, it can also be used successfully in adults, with very good results. The rate of wound healing, infection and complications is the same as in children, as are the cosmetic and functional outcomes., Objectives: To evaluate the outcome of uretero-ureterocutaneostomy (UUC) wrapped by omentum for palliative cystectomy in symptomatic elderly high-risk patients with high-stage bladder cancer., Patients and Methods: The study included 15 patients (14 men and one woman, aged 72-87 years, American Society of Anesthesiology score 3) with symptomatic recurrent bleeding bladder cancer (T2/T3) who were treated with palliative cystectomy. UUC was performed by mobilizing the right pre-vesical divided ureter up to the pelvi-ureteric junction and a high retroperitoneal crossover to the divided left ureter. A stoma was created with a circular 2-cm skin excision and resecting the fatty subcutaneous tissue. Wrapped by the omentum, both well-vascularized ureteric stumps were pulled through a cross-like fascia incision up to skin level. Spatulated and everted, the 'butterfly' flaps were fixed to the skin and underlying omentum. Soft splints were inserted for 21 days and a Karaya ring placed., Results: The postoperative course and stoma healing was normal in 14 of the 15 patients; the sigmoid was resected because of sigmoid diverticulitis in one. The median (range) follow-up was 15 (6-24) months. There was pyelonephritis in one patient, and the dilatation of the upper tract (grade 3) in two returned to grade 2, with new asymptomatic grade 1 dilatation in one other. All patients were without stents and stoma care was provided at home., Conclusions: This modified UUC by omental wrapping in 15 high-risk patients after palliative cystectomy was simple and safe, and their recovery was uneventful. To date the few patients with stomal obstruction were managed by J catheters, changed every 4-6 months.

Purpose: Earlier anatomical studies have shown a close connection between the ureterovesical junction and detrusor innervation. It prompted us to develop an animal model to demonstrate the risk of partial or complete impairment of this neuronal connection during antireflux surgery., Materials and Methods: Six female Göttinger minipigs were anesthetized and laminectomized. After placement of the S3 sacral nerves into separate electrode compartments of a modified Brindley electrode the lower urinary tract was exposed by an abdominal midline incision. After bladder instillation with 150 ml NaCl 1 bilateral and 2 unilateral stimulations (left and right sides) were performed and intravesical pressure was recorded urodynamically. The left ureter was then prepared circularly in 3 steps 10, 5 and 1 cm, respectively, proximal to the ureterovesical junction. After each preparation step bilateral and unilateral stimulation was repeated. Results were recorded urodynamically and video documented., Results: Bilateral stimulation before preparation of the left ureter led to a concentric detrusor contraction with an average maximum detrusor pressure of 51 cm H(2)O. Unilateral stimulation resulted in ipsilateralbound bladder tilting with an intravesical pressure of 18 and 19 cm H(2)O on the right and left sides, respectively. After preparation of the left ureter 10, 5 and 1 cm from the ureterovesical junction a maximum detrusor pressure of 17, 10 and 1 cm H(2)O was documented, respectively. While there was almost no stimulation response of the bladder after the last preparation step at 1 cm on the left ureter, the initial bladder pressure of 18 cm H(2)O could be reproduced under stimulation on the right side., Conclusions: Analogous to human cadaver studies, we were able to prove neurophysiologically strictly unilateral detrusor innervation, drawing from the pelvic plexus dorsomedial to the ureterovesical junction into the bladder. Preparation of this ureterovesical junction during antireflex surgery, coagulating measures in this area or the affixation of anchor sutures after a Vest suture involves the risk of unilateral or bilateral detrusor decentralization.

Iatrogenic ureteral lesion is a severe complication in gynecological surgery. We present a case in which the obstruction led to fornix rupture, urine extravasation and urinary ascites. The problematic diagnostic pathway is emphasized.

The Lich-Gregoir antireflux procedure is a simple and safe method for the treatment of primary reflux of all grades if the ureter is not grossly dilated on the excretory urogram. Reflux was cured in 97.7 per cent of 429 ureters in 371 children. A stenosis of the terminal ureter requiring reimplantation occurred in 0.5 per cent. The over-all rate of reinterventions was 3.7 per cent. This low complication rate makes surgical correction of reflux advisable if urinary tract infection and primary reflux cannot be eradicated by continuous antimicrobial therapy within 6 months.

Blind-ending bifid ureters, as one type of duplications, are a rare congenital anomaly of the urinary tract. Occasionally they present with unspecific symptoms and require surgical intervention. This case of a blind-ending bifid ureter was associated with an intravesical ectopic orifice. Recurrent urinary tract infection necessitated excision of the blind branch and ureteroneocystostomy using the psoas-hitch technique.

In 13 dogs the middle one-third of the ureter and in four dogs the entire ureter was replaced by fresh Rhesus monkey or human umbilical cord vein. The overall success rate was 60 per cent (10/17); one dog revealed an excellent intravenous pyelogram; the typical roentgenographic appearance of the kidney was a slight hydronephrosis. Animals surviving for more than 1 year were nephrectomized on the contralateral side. One dog is still alive at 36 months. Histologically, the typical structures of the umbilical vein remained unchanged after 2 years, but endothelium was replaced by urothelium. The umbilical vein seems to be an embryonic tissue of extremely low antigenicity and therefore suitable for transplantation.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ. In a retrospective study, 43 adult patients with 54 primary obstructed megaureters (male:female = 30:13) were studied. This diagnosis excluded infravesical obstruction, reflux and neurogenic disorders. The main symptoms were flank pain, infection and hematuria. An operation was performed in 25 patients; 29 were treated conservatively. The criteria for surgery are discussed in relation to symptoms, functional reserves of the kidney, transportation capacity of the upper urinary tract, and histological changes of the narrow segment of the ureter. Operative treatment should be limited to well-defined complications, such as deterioration of kidney function or recurrent infection, to avoid its discredit as merely a cosmetic procedure.