Urethral replacement with ureter.

Proximal or total urethral replacement was performed in 8 patients using distal ureter. This was accomplished by basing the ureteral segment solely on a vascular pedicle arising from the internal iliac artery. Diagnoses included classical bladder exstrophy in 4 patients, cloacal exstrophy in 3 and an imperforate anus with hypoplasia of the bladder neck and urethra in 1. Continence was achieved by a tunneled submucosal reimplantation into either the bladder (4 cases), gastric reservoir (2) or colonic reservoir (2). Although an isolated distal segment of ureter was used in each case, all segments have remained viable. With limited followup (5 to 44 months) continence with either normal voiding or intermittent catheterization has been achieved in 7 of the 8 patients. A distal ureteral segment should be considered potentially useful in the construction or reconstruction of the proximal (male) or total (female) urethra in patients with congenital urethral malformations.