Purpose: Megaureter represents the ideal tissue for bladder augmentation but to date ureterocystoplasty has been used only in select cases. We demonstrate that ureterocystoplasty can be used more frequently by dividing the megaureter and using its distal part for bladder augmentation and proximal part for reimplantation into the bladder. This technique can be performed as a 1 or 2-stage procedure.

Materials and methods: From November 1995 to October 1998 ureterocystoplasty was performed in 16 patients 3 to 12 years old (mean age 6.6). In 9 cases with impaired renal function loop cutaneous ureterostomy had been previously done to preserve and improve renal function. In the remaining 7 cases bladder augmentation and simultaneous ureteroneocystostomy were performed without cutaneous ureterostomy. Ureterocystoplasty was done extraperitoneally. This distal part of megaureter was used for bladder augmentation and the proximal part was implanted into the bladder using extravesical detrusor tunneling ureteroneocystostomy in a majority of cases.

Results: Followup ranged from 12 months to 4 years (mean 2.8). The new increased bladder capacity ranged 296 to 442 ml. (mean 371) in both groups. Compliance was improved in all cases with a decrease in the number of clean intermittent catheterizations daily, and there was no further worsening of renal function. Vesicoureteral reflux was noted in 3 patients without clinical symptoms.

Conclusions: Megaureter presents the ideal tissue for bladder augmentation. Division of the ureter and use of its distal part for augmentation is always possible. Augmentation ureterocystoplasty performed this way can be done more frequently.