Ureterocystoplasty with preservation of ipsilateral renal function.

Recently the ureter has been used for bladder augmentation in selected patients with abnormal bladders and dilated upper tracts. The ureter has several advantages over other forms of bladder augmentation because it alleviates electrolyte disturbances, mucous production, and the disruption of the gastrointestinal tract. Initial reports emphasized the use of the entire ureter and renal pelvis in patients with an ipsilateral dilated nonfunctioning renal unit. Herein the authors report five cases of ureterocystoplasties performed since July 1993, in which the ipsilateral renal unit was preserved. All patients underwent preoperative videourodynamic studies, which showed small-for-age bladder capacity and poor compliance. Three patients underwent unilateral ureterocystoplasty, and two had bilateral ureterocystoplasty. Transureteroureterostomy (TUU) was performed in all patients, and most of the ipsilateral dilated ureter was used for augmentation. In two patients who had partial unilateral duplication, ipsilateral upper-to-lower ureteropyelostomy was done in addition to the TUU to maximize the amount of ureter available for augmentation. The follow-up period ranges from 6 to 24 months. All patients are continent and free of vesicoureteral reflux. All show stabilization or improvement of their upper tracts. Pressure-specific bladder capacity (bladder capacity at 30 cm of water pressure) increased by 350% (from a mean of 142 mL to 500 mL). The ureter is an excellent choice for augmentation cystoplasty in selected patients. An ipsilateral functioning renal unit is not a contraindication for ureterocystoplasty.