Direct nipple ureteroneocystostomy in adults with primary obstructed megaureter

Purpose: We evaluated the results of direct nipple ureteroneocystostomy technique in adults with primary obstructed megaureter. Materials and Methods: Five patients with a mean age of 32.5 years had a total of 6 primary obstructed megaureters with complaints of flank pain. Two patients were female and 3 were male. In patient 1 disease was bilateral, in 3 it was on the right side and in 1 it was on the left side. In male patient 1 a thick walled right ureter could be directly inserted into the bladder without eversion or tapering. The left nipple was created with spatulation. In 2 cases the ureters were thin walled (2 mm or less) and the nipples were created without spatulation. In the other 2 cases the nipples were created following spatulation since the ureteral walls were thicker (2 to 3 mm). Results: Mean followup was 36 months. Flank pain complaints resolved in the postoperative period. Early postoperative Whitaker tests revealed nonobstructed renal units. At later followup visits excretory urograms and/or ultrasound showed partially resolved hydroureteronephrosis. Conclusions: Ease of application, a high success rate and no need to taper or plicate the ureter, or prepare a submucosal tunnel might be the reasons to consider the direct nipple technique for megaureters of different etiologies.