Megaüreteri̇n cerrahi̇tedavi̇si̇nde i̇ki̇tekṅiǧ̇in deǧerlendi̇ri̇lmesi̇: Eksi̇zyonel daraltma ve Starr pl̇ikasyon

Introduction: The aim of the study is to evaluate the outcome of excisional tapering and Starr plication for ureteral tailoring in megaureter reimplantation. Materials and Methods: A total of 35 patients with megaureter (obstructive or refluxive) who underwent ureteral reimplantation with Starr plication and 7 cases with excisional tapering were included to the study. The 2 groups of patients were compared with regards to postoperative reflux and obstruction. Results: The mean age of the patients was 4.9±4.6 (range: 4 month-9 year) years. The diagnosis was primary megaureter in 30 (refluxive in 10, obstructive in 20) and secondary megaureter in 12 (refluxive in 10, obstructive in 2) patients. Secondary megaureter was due to posterior urethral valve in 8, neuropathic bladder in 4 cases. The ureters were reimplanted using the Cohen transtrigonal technique in 32, Politano-Leadbetter in 7, psoas hitch in 2 and Le Due in 1 patient. Bilateral Starr plication was performed in 7 cases. The mean follow-up was 3.6±2.4 years. Postoperative reflux was developed in 1 (4%) of 25 renal units with primary megaureter who underwent reimplantation with Starr plication and was followed-up conservatively. Of 7 patients with excisional tapering postoperative obstruction was noted in 1 (%14.3) cases. No significant difference was detected with regard to postoperative complications between Starr plication and excisional tapering groups who had primary megaureter. In Starr plication group who had secondary megaureter, postoperative reflux was detected in 4 (23.5%) of the 17 renal units and obstruction in 1 (5.9%) renal unit. Three patients with low grade reflux were managed conservatively, while reimplantation was done to 1 case. Psoas hitch reimplantation was performed to 1 patient with postoperative obstruction. In Starr plication group, postoperative complications were more frequently detected in patients with secondary megaureter when compared to patients with primary megaureter (23.5% vs 4%, p=0.02). Conclusion: Excisional tapering and Starr plication had similar long-term success and complication rates in patients with megaureter. The primary pathology causing megaureter was more significant in terms of surgical success rather the surgical technique for ureteral tailoring.