Recent advances and further experience with surgical techniques for one-stage total remodeling of massively dilated ureters.

One-stage total ureteral remodeling was done in a selected group of 64 megaureters in 44 children. Two new surgical techniques have been developed and utilized during the past six years. They were designed to preserve the ureteral blood supply and accomplish reconstruction of the whole ureter in one operation. The tapering in situ technique was utilized in 39 ureters and ureteral plication either alone or in conjunction with lower-third ureteral tapering in 25 ureters. These methods proved to be invaluable in the following selected cases: (1) massive ureteral dilatation and tortuosity due to vesicoureteral reflux or obstruction, (2) secondary operations following previous urinary diversion or unsatisfactory ureteral tailoring, (3) multiple obstructions within the same ureter, (4) transureteroureterostomy of dilated ureters, and (5) definitive surgery for dilated ipsilateral ureter of complete duplication.