Laparoscopic pneumovesical ureteral tapering and reimplantation for megaureter.

Abstract:

OBJECTIVE:To evaluate the efficacy of laparoscopic pneumovesical ureter reimplantation for congenital malformation involving the vesicoureteral junction in children. METHODS:From January 2005 to October 2010, 45 cases (comprising 61 ureters) were diagnosed as megaureter caused by vesicoureteral junction obstruction. A pneumovesical laparoscopic Cohen procedure was performed in all cases. Twelve of the ureters underwent excisional ureteral tapering. Ureteral diameters were obtained using ultrasonography and were divided into 4 groups according to the degree of dilatation. RESULTS:The procedure was completed in all but 2 patients, who were converted to open surgery. The mean operation time was 3.5h (range, 2-8h) for unilateral ureter cases, 3.7h (range, 3.5-4.5h) for duplicated ureter cases, and 5.4h (range, 3.5-9h) for bilateral cases. The mean duration of urethral catheter placement and hospital stay was 6.7 days (range, 3-14 days) and 8.3 days (range, 4-15 days), respectively. Thirty-five of the patients (48 ureters) were followed up by ultrasonography for 1-67 months (mean, 19.3 months). Ultrasound scans revealed improvement in the degree of dilatation of 32 ureters. In 1 patient, the ultrasound scan showed deterioration of ureteral dilatation. This patient developed stenosis at the neoureteral opening and underwent reoperation 6 months later. Fourteen patients were followed up by micturating cystourethrogram (MCU).Of these, 3 cases (4 ureters) exhibited reflux (2 unilateral cases of grade 1 reflux and grade 3 reflux, respectively, and 1 bilateral case of bilateral grade 1 reflux). CONCLUSIONS:Pneumovesical ureteral reimplantation for vesicoureteral junction obstruction is feasible and effective. In this series, ultrasound scans showed improvement in most ureteral dilatation cases on follow-up.

journal_name

J Pediatr Surg

authors

Bi Y,Sun Y

doi

10.1016/j.jpedsurg.2012.09.020

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

2285-8

issue

12

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(12)00722-1

journal_volume

47

pub_type

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