Postoperative Urosepsis Research Articles

Comparison of single-use flexible URS and re-usable flexible URS: Effectiveness, reliability, cost-efficiency analysis

Comparison of Single-use Flexible Ureterorenoscopy (SF-URS) with Reusable Fiberoptic Flexible Ureterorenoscopy (RF-URS) is one of the most popular subject in Endourology. Flexible Ureterorenoscopy (F-URS) is the gold standard method used in the treatment of kidney and ureteral stones smaller than 2 cm and together with ESWL.SF-URS has been widely used along with RF-URS. Our study aims to analyze retrospectively RF-URS and SF-URS in terms of effectiveness, reliability and cost. 200 patients who underwent F-URS due to renal stones were included in our study. Patients were divided into 2 groups: 100 patients who underwent SF-URS and 100 patients who underwent RF-URS. Mean age of the two groups was 49.58, 50.24 in the RF-URS and SF-URS groups, respectively. The presence of hypertension and diabetes, Body Mass-Index (BMI), and stone characteristics were recorded, and postoperative stone-free rates, duration of hospital stay, duration of operation, postoperative hemoglobin loss, postoperative urosepsis, and auxiliary procedures were evaluated. A cost effective analysis was carried out. The demographic data and stone characteristics of both groups were similar and there was no statistically significant difference (p> 0.05). The SF-URS group was found to be more advantageous in terms of the duration of operation (p0.05). The RF-URS group was found to be more advantageous after a cost-effective analysis (p

Clinical Significance of DJ Stent Culture in Patients with Indwelling Ureteral Stents Prior to Endourological Intervention- A Single Centre Prospective Cohort Study

Introduction: Ureteral Double J Stenting (DJS) is commonly done prior to endourological interventions for various indications. Aim: To compare Urine Culture (UC) with DJ Stent Culture (SC) in patients with indwelling ureteral stents prior to endourological intervention and to evaluate the clinical significance of SC with postendourological intervention sepsis. Materials and Methods: A prospective single centre observational study was conducted in the Department of Urology, Army Hospital Research and Referral, New Delhi, India, from August 2017 to March 2019. A total of 100 patients underwent DJS prior to definitive endourological intervention. Patient's demographic profile was recorded along with preoperative, intraoperative and postoperative parameters. UC was also recorded at these intervals along with SC. The data was analysed and compared using Statistical Package for the Social Sciences (SPSS) software. Results: Intraoperative UC of 14 patients were colonised, SC was colonised in 11 patients. Six patients developed Urosepsis, Postoperative UC was colonised in four patients. The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of intraoperative UC for detecting stent colonisation with identical pathogens were 63.64%, 92.13%, 50.00% and 95.35%, respectively. Patients with colonised intraoperative UC, SC cranial tip and SC caudal tip had sepsis rates of 28.6%, 50%, and 44.4%, respectively. The sensitivity and PPV of SC in predicting postoperative sepsis were low at 83.33% and 45.45%, respectively, whereas the specificity and NPV were high at 93.6% and 98.8%. A 15.8% of diabetic patients and 50% immunocompromised patients developed urosepsis. E.Coliwas the commonest isolated pathogen from UC and SC. On univariate logistic regression analysis, operative time, positive intraoperative UC, positive SC were associated with postintervention sepsis. While on multivariate analysis, none of these factors were associated with postendourological intervention sepsis. Conclusion: Performing routine SC may not be cost effective but could be recommended in cases at higher risk of developing postoperative urosepsis such as those with Diabetes Mellitus (DM) or immunocompromised patients and those expected to take longer operative time.

Clinical significance of DJ stent culture in patients with indwelling ureteral stents prior to endourological intervention.

Ureteral stents are placed to relieve ureteral obstruction in various endourological surgery. As soon as it is inserted it is rapidly colonized by host of microorganism. Culture and sensitivity pattern of these growing microorganism on the stent may provide us an insight to treat postoperative urosepsis in high risk patients with indwelling DJ stents. Prospective study between September 2018 and August 2019 with enrollment of 100 patients to determine the ability of urine culture (UC) to predict stent culture (SC) status, to identify associated infectious pathogens with their antibiotic sensitivity patterns and to evaluate the association between SC and post-endourological intervention sepsis. Colonization of bacteria on stent culture (SC) was identified in 53 out of 100 patients (53%). Most of the organism grown on SC were multidrug resistant and they were resistant to most commonly prescribed antibiotics like fluroquinolones, cephalosporins, and aminoglycosides .These organisms were only sensitive to newer antibiotics. Indwelling time of ureteral stent was directly proportional with SC positivity (p < 0.05). Association of Urine culture at DJ Removal and DJ stent culture was not statistically significant. Very low rates of colonization within 6 weeks after the insertion of stents. Sterile culture of urine does not rule out colonization of the stent. Most of the urinary pathogens as well as the organisms grown on DJ stent are resistant to fluroquinolones and cephalosporins.

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection

The purpose of this study was to assess risk factors of urosepsis after minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of upper urinary tract stones in patients with preoperative urinary tract infection (UTI) and to explore preventive measures. Between 2008 and 2016, patients with preoperative UTI who underwent MPCNL for upper urinary tract stones were retrospectively collected. Patients were divided into nonurosepsis and urosepsis groups. Perioperative outcomes of all patients were evaluated and compared between the two groups. Risk factors for post-MPCNL urosepsis were investigated using univariate and multivariate regression analysis. A total of 843 patients including 22 patients with postoperative urosepsis (urosepsis group) and 821 patients without urosepsis (nonurosepsis group) were finally included in this study. All patients with postoperative urosepsis were cured and discharged after treatment. In univariate analysis it was demonstrated that the incidence of urosepsis after MPCNL was significantly correlated with channel size (P=0.001), surgical time (P=0.003), as well as the tear of the collection system and percutaneous renal channel crossing the renal papilla (P=0.004). Moreover, multivariate analysis showed that smaller channel size (OR = 11.192, 95% CI: 2.425–51.650, P=0.002), longer surgical time (OR = 6.762, 95% CI: 1.712–17.844, P=0.008), and tear of collection system and percutaneous renal channel crossing the renal papilla (OR = 5.531, 95% CI 1.228–14.469, P=0.012) were independent risk factors for urosepsis following MPCNL in patients with preoperative UTI. In conclusion, in patients with preoperative UTI undergoing MPCNL for upper urinary tract stones, smaller channel size, prolonged operation time, as well as tear of the collection system and percutaneous renal channel crossing the renal papilla are independent risk factors for postoperative urosepsis. Therefore, it is indicated that, in clinical practice, it is of great significance to choose appropriate channel size and avoid renal injury and control surgical time to prevent the urosepsis after MPCNL in patients with preoperative UTI.

Identification of Factors Associated with Postoperative Urosepsis after Ureteroscopy with Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy

Objective: To report the incidence and risk factors of urosepsis after ureteroscopic lithotripsy (URSL). Patients and Methods: We retrospectively reviewed 1,421 patients who underwent URSL for ureteral calculi between July 2015 and June 2018 at our department to identify factors predicting postoperative urosepsis. Demographic characteristics, clinical data, operative information, and complications were compared, and risk factors of postoperative urosepsis were identified and analyzed. Results: Of the 1,421 patients treated with URSL using holmium: yttrium-aluminum-garnet laser, 12 (0.8%) developed a urosepsis after operation. The positive preoperative multidrug resistance (MDR) urine culture and operative duration were statistically different between those who did and did not develop a urosepsis (4.61 vs. 25%, p = 0.017; 70 vs. 62 min, p < 0.001). However, patient age, sex, body mass index, diabetes mellitus, history of urolithiasis, positive preoperative urine cultures, stone size and location, degree of hydronephrosis, and prior stent placement were similar in 2 groups. Multivariate analysis revealed that positive preoperative MDR urine culture and long operation duration significantly increased the risk of postoperative urosepsis (OR 5.090, 95% CI 1.312–19.751, p = 0.019; OR 1.034, 95% CI 1.004–1.063; p = 0.024). Matched-pair analysis demonstrated that positive preoperative MDR urine culture and operation duration were significantly associated with postoperative urosepsis (OR 15.77, 95% CI 1.033–240.7, p = 0.047; OR 1.087, 95% CI 1.011–1.169, p = 0.025). Conclusions: Patients with positive preoperative MDR urine culture or long operation duration had a higher risk of developing urosepsis after URSL. When treating patients who present with positive preoperative MDR urine culture or long operation duration, urologists should be vigilant and aware of the potential risk of urosepsis.

The utility of preoperative and intraoperative cultures for guiding urosepsis empirical treatment

Objective: Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Methods: Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. Results: The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. Conclusions: To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b

Risk factors and outcomes of urosepsis in patients with calculous pyonephrosis receiving surgical intervention: a single-center retrospective study

BackgroundUrosepsis is a catastrophic complication, which can easily develop into septic shock and lead to death if not diagnosed early and effectively treated in time. However, there is a lack of evidence on the risk factors and outcomes in calculous pyonephrosis patients. Therefore, this study was conducted to identify risk factors and outcomes of intra- and postoperative urosepsis in this particular population.MethodsClinical data of 287 patients with calculous pyonephrosis were collected. In the univariate and multivariate analysis, all patients were divided into urosepsis group and non-urosepsis group. The diagnosis of urosepsis was mainly on the basis of the criteria of American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM). Patient characteristics and outcomes data were analyzed, and risk factors were assessed by binary logistic regression analysis.ResultsOf 287 patients, 41 (14.3%) acquired urosepsis. Univariate analysis showed that white blood cell (WBC > 10*10^9/L) before surgery (P = 0.027), surgery types (P = 0.009), hypotension during surgery (P < 0.001) and urgent surgery (P < 0.001) were associated with intra- and postoperative urosepsis for calculous pyonephrosis patients. In multivariate analysis, hypotension during surgery and urgent surgery were closely related to intra- and postoperative urosepsis. Outcome analysis suggested that patients developing urosepsis had a longer intensive care unit (ICU) stay and postoperative hospital stay and higher mortality.ConclusionsHypotension during surgery and urgent surgery were risk factors of intra- and postoperative urosepsis for calculous pyonephrosis patients, which may lead to a prolonged ICU stay, postoperative hospital stay and higher mortality.

Diagnostic and Prognostic Values of BMPER in Patients with Urosepsis following Ureteroscopic Lithotripsy.

The present study aims to investigate the risk factors for urosepsis and the diagnostic and prognostic values of the bone morphogenetic protein endothelial cell precursor-derived regulator (BMPER) in patients with urosepsis following ureteroscopic lithotripsy. A total of 305 patients with unilateral ureteral obstruction caused by calculi were included in the study. Patients were divided into three groups, namely, high, medium, and low perfusion pressure groups. The serum C-reactive protein, procalcitonin, lactate (LAC), and BMPER were measured after operation. A logistic regression model was used to assess the risk factors for postoperative urosepsis. The relationships of BMPER with laboratory parameters were explored with a multiple linear regression model. Receiver operating characteristic (ROC) curves were used to diagnosis urosepsis. The cumulative incidence of the adverse events after operation was calculated and compared by log-rank test. Forty-five patients (14.8%) had an episode of urosepsis after operation. Irrigation pressure was an independent risk factor for urosepsis. LAC and sequential organ failure assessment (SOFA) were associated with BMPER after operation. The area under curve value of BMPER for urosepsis was 0.829 (95% confidence interval [CI], 0.773 to 0.884). Uroseptic patients with higher BMPER concentration exhibited more adverse outcome. BMPER possesses valuable discriminative capacity for urosepsis and is a strong predictor of adverse outcome in patients with urosepsis.

Clinical value of procalcitonin in early diagnosis of prostoperative urosepsis after percutaneous nephrolithotomy

Objective By detecting procalcitonin level change, to analysis the clinical value of procalcitonin in early diagnosis of postoperative urosepsis after percutaneous nephrolithotomy(PCNL). Methods Eight hundred and seventy-six patients underwent percutaneous nephrolithotomy of the upper urinary stones were divided into two groups, 56 cases of postoperative urosepsis in observation group (PCNL), 820 cases in control group. Preoperative and postoperative 6 h PCT level of two groups were compared and analyzed. Results Two groups were completed smoothly PCNL. Preoperative PCT of observation group was (0.024±0.006) ng/mL, and postoperative 6 h PCT was (5.21±2.22)ng/mL, preoperative PCT of control group was (0.026±0.007) ng/mL, postoperative 6 h PCT was (1.31±0.29) ng/mL, Preoperative PCT levels of two groups were in normal range, there was no statistically significant difference between the two groups(P>0.05). Comparison of postoperative PCT before and after operation in two group was different degree rise, the differences were statistically significant(P<0.05), after 6 h PCT of two groups was compared, difference was statistically significant(P<0.05). Conclusions PCT levels of patients with suspected secondary sepsis after PCNL are detected , which will help to the early clinical diagnosis of urinary sepsis. Key words: Toxemia; Calcitonin; Nephrostomy, Percutaneous

Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones.

To obtain more accurate and rapid predictors of postoperative infections following percutaneous nephrolithotomy (PCNL) in patients with complex kidney stones, and provide evidence for early prevention and treatment of postoperative infections. A total of 802 patients with complex kidney stones who underwent PCNL, from September 2016 to September 2017, were recruited. Urine tests, urine cultures (UCs) and stone cultures (SCs) were performed, and the perioperative data were prospectively recorded. In all, 19 (2.4%) patients developed postoperative urosepsis. A multivariate logistic regression analysis revealed that an operating time of ≥100 min, urine test results with both positive urine white blood cells (WBC+) and positive urine nitrite (WBC+NIT+), positive UCs (UC+), and positive SCs (SC+) were independent risk factors of urosepsis. The incidence of postoperative urosepsis was higher in patients with WBC+NIT+ (10%) or patients with both UC+ and SC+ (UC+SC+; 8.3%) than in patients with negative urine test results or negative cultures (P < 0.01). Preoperative WBC+NIT+ was predictive of UC+SC+, with an accuracy of >90%. The main pathogens found in kidney stones were Escherichia coli (44%), Proteus mirabilis (14%) and Staphylococcus (7.4%); whilst the main pathogens found in urine were E. coli (54%), Enterococcus (9.4%) and P. mirabilis (7.6%). The incidence of E. coli was more frequent in the group with urosepsis than in the group without urosepsis (P < 0.05). WBC+NIT+ in preoperative urine tests could be considered as an early and rapid predictor of UC+SC+ and postoperative urosepsis. Urosepsis following PCNL was strongly associated with E. coli infections in patients with complex kidney stones.

Analysis of Factors' Association with Risk of Postoperative Urosepsis in Patients Undergoing Ureteroscopy for Treatment of Stone Disease

To investigate which patient, stone, infective, and surgical factors were most likely to increase the risk of postoperative urosepsis within 28 days of ureteroscopy (URS) and laser stone fragmentation for ureteral or renal stones. Data were collected prospectively in a single National Health Service institution. A logistic regression model was used to assess the association of factors with postoperative urosepsis. Two matched-pair analyses were used to assess the risk of postoperative urosepsis in patients with (a) an emergency presentation to hospital with urosepsis in the 90 days preceding URS and (b) a positive midstream sample of urine (MSSU) identified, but who were asymptomatic at preoperative assessment, who then received an appropriate course of antibiotics. Four hundred sixty-two consecutive patients were included in the study. Thirty-four patients (7.4%) had an episode of urosepsis within 28 days of their operation. A positive preoperative MSSU was significantly associated with postoperative urosepsis on multivariable analysis, despite appropriate treatment with a preoperative course of antibiotics: odds ratio (OR) 4.88, 95% confidence interval (CI) 2.11, 11.31, p < 0.001. The presence of diabetes mellitus, presence of ischemic heart disease, patient American Society of Anesthesiologists score, same-session bilateral URS, and stone volume were the other variables significantly associated with postoperative infection on univariable analysis, but these ceased to be significantly associated on multivariable analysis. Subgroup analysis found that a positive MSSU in both patients with a preoperative ureteral stent and those without was significantly associated with postoperative urosepsis, however, the OR was much lower for the stented group (OR 3.23 vs OR 16.67). On matched-pair analysis, patients with a positive preoperative MSSU were significantly more likely to have postoperative urosepsis compared to controls (OR 17.46, 95% CI 2.18, 139.80, p = 0.007). There was no significant difference in the OR of postoperative urosepsis in patients who had a preceding urine infection requiring hospital admission in the 90 days preceding URS (OR 0.60, 95% CI 0.19, 1.92, p = 0.39). Positive preoperative MSSU was significantly associated with postoperative urosepsis by logistic regression and matched-pair analysis. These higher risk patients should be counseled appropriately before surgery, and should be the focus of vigilant postoperative monitoring. The study suggests particular caution in patients with a positive preoperative MSSU without a preoperative ureteral stent.

Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for Non-infection.

Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively, in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015, 5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study. These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory Results, while they had no infection in their blood and urine preoperatively. Without delay, 5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours. The body temperature was recovered to normal in 2 or 3 days, and the blood and urine test Results were not abnormal in 7 days. At last, 5 patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy. Especially for patients who had not presented infection preoperatively, careful preparation preoperatively, corrective manipulation, low pressure irrigation, drainage and controlling time during operation, and early diagnosis, appropriate treatment postoperatively are the key to cure and prevent urosepsis.

Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone: Technique and outcomes

ObjectiveTo describe the technique and outcomes of antegrade ureteroscopic assistance during the initial nephrostomy access for the management of renal staghorn stone. Materials and methodsFrom 2000 to 2009, a total of 153 patients with complete staghorn stones were treated with percutaneous nephrolithotomy (PCNL) at our hospital. Antegrade ureteroscopic assistance was applied, starting in the 50th patient, during the initial nephrostomy access so as to prevent the creation of a false tract and to create more intracalyceal space for subsequent tract dilation. We report the characteristics of the patients, stones, treatment outcomes, and complications in the groups with and without antegrade ureteroscopic assistance. ResultsIntergroup differences in the groups with (n = 104) and without (n = 49) antegrade ureteroscopic assistance with regard to the patients' characteristics and stone surface areas were not significant (24.0 ± 18.1 cm2 versus 21.8 ± 11.8 cm2). Patients who underwent PCNL with antegrade ureteroscopic assistance required a significantly shorter operation time and hospital stay than those who underwent PCNL without antegrade ureteroscopic assistance (143 ± 78 minutes versus 105 ± 35 minutes, p < 0.0001; 5.4 ± 2.9 days versus 4.3 ± 2.2 days, p = 0.009, unpaired t test). Furthermore, intergroup differences with regard to the stone-free rate, transfusion rate, and incidence of postoperative urosepsis were not statistically significant (p = 0.67, p = 0.18, and p = 0.75, respectively). ConclusionSuch an ancillary procedure might be suitable for the management of complete staghorn stones or other complex renal stones in patients in whom adequate intracalyceal space was not available for the creation of nephrostomy access.

E178 What predicts post-operative uro-sepsis in patients undergoing ureteroscopy lasertripsy (URSL) for stones: Evidence from a prospective study

E178 What predicts post-operative uro-sepsis in patients undergoing ureteroscopy lasertripsy (URSL) for stones: Evidence from a prospective study

Modified extravesical ureteral reimplantation technique for kidney transplants

We describe a modification and evaluate a technique of extravesical ureteral reimplantation for kidney transplant. We reviewed the records of 120 kidney transplant recipients who underwent ureteral reimplantation via a modified extravesical technique. Follow-up evaluation included renal ultrasonography. Because reflux is not routinely assessed in transplant cases, only symptomatic reflux was considered a complication and accessed with voiding cystourethrography (VCUG). The urological complications evaluated included urinary fistula, ureteral stenosis and symptomatic vesicoureteral reflux. The modified extravesical technique produced a successful result in 93.4% of patients with no symptomatic reflux or anastomotic obstruction. Anastomotic complications included stenosis in four patients, prolonged leakage and fistula in three patients, and symptomatic vesicoureteral reflux in one patient. Other urologic complications included complicated hematuria in three patients, postoperative urosepsis in one patient, and ureteral stenosis caused by extrinsic compression in three patients due to lymphocele (two patients) and by adhesions (one patient). The modified extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more-traditional techniques and proved to be efficient without increasing the incidence of urological or anastomotic complications. This modified technique offers two advantages; removal of the ureteral stent with the urethral catheter without the need for a postoperative cystoscopy and facilitation of postoperative endoscopic maneuvers if needed.

Psoas hitch ureteral reimplantation in adults—analysis of a modified technique and timing of repair

Objectives. The psoas hitch ureteral reimplantation technique has been used with great success to bridge defects in ureteral length due to injury or planned resection. Several surgical principles have been historically stressed when performing this procedure, including adequate mobilization of the bladder, fixation of the bladder to the psoas tendon before reimplantation, the use of a submucosal nonrefluxing-type ureteral anastomosis, and a 6-week delay before attempting repair after a surgical injury. We retrospectively reviewed patients who underwent ureteroneocystostomy with a psoas hitch, evaluated the relevance of these principles, and describe a modification of the technique. Methods. All patients undergoing psoas hitch ureteral reimplantation were reviewed. The indications, complications, and long-term outcomes were assessed. Results. Between 1989 and 1999, 24 patients underwent psoas hitch reimplantation at our institution. The indications were operative injury in 11, planned surgical resection during nonurologic pelvic surgery in 4, cancer in 4, stricture in 4, and trauma in 1. Refluxing-type ureteral anastomoses were performed in 17 cases. One case of postoperative urosepsis occurred. A delayed repair after operative injury did not improve the operative time or overall morbidity. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis, or compromised renal function, as measured by a change in baseline serum creatinine level, occurred. No patient required reoperation for either early or delayed complications or failure of the repair at a follow-up of 1 to 122 months (mean 32.75). Conclusions. Psoas hitch ureteral reimplantation is an effective means of treating defects in ureteral length. Immediate repair may be safely undertaken as soon as the ureteral injury is recognized. Long-term sequelae are unusual in adults, even when using refluxing-type ureteral anastomoses.

Extravesical Ureteral Reimplantation: Results in 128 Patients

Purpose We evaluated the results of extravesical ureteral reimplantation in children. Materials and Methods We reviewed the records of 128 children (174 ureters) who underwent ureteral reimplantation via extravesical techniques. Primary vesicoureteral reflux was the most common diagnosis (73 patients). Results The extravesical technique produced a successful result in all patients (no reflux or obstruction). The 2 complications included postoperative urosepsis and transient urinary retention. Conclusions Extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more traditional intravesical techniques.