Pneumovesicoscopic ureteral reimplantation with intravesical tailoring of obstructive megaureter in pediatric patient.

INTRODUCTION: According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with ex vivo tailoring in children. AN OBJECTIVE: To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children. STUDY DESIGN: Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25 mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star). RESULTS: 43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142 min (83-235 min). The mean manipulation time for intravesical tailoring of the megaureter was 18 min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1-3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful. DISCUSSION: This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period. CONCLUSIONS: The use of the Tuohy needle with the loop simplifies the fixation of the ureter. This helps to make the intravesical tailoring of the megaureter easier and faster. It is original and less traumatic for the ureter than existing methods.

Bilateral ureteral triplication: A case report.

Ureteral triplication is among the rarest congenital disorder of the urinary tract. A review of the literature has shown that only about one hundred cases have been reported worldwide. The reports on bilateral ureteral triplication cases, however, are extremely scarce. A female infant was presented with a history of recurrent febrile UTI since birth. Computed tomography urography scan revealed bilateral ureteral triplication. Combination of contrast studies and endoscopic procedure were utilized to establish the diagnosis. Management for this anomaly varies from conservative to interventional surgery. This patient underwent laparoscopic left ureteroneocystostomy and ureteral tailoring.

Clinical Observation on Ureteral Tailoring in 13 Cases / 대한비뇨기과학회지

A clinical observation was made on 13 cases (15 ureters) who were performed ureteral tailoring at the Department of Urology, Catholic Medical College, from 1968 to 1981. Clinical observation was included age and sex distribution, indication for operation, methods of operation, duration of indwelling ureteral splint catheter and complications. The results were as follows: 1. Ureteral tailoring was performed in the case of severe dilated ureter due to ureteral obstruction, V-U refiuxand/or megaloureter. 2. Most case had undergone antirefiux procedures except 2 cases: 12 ureters of 10 cases underwent antirefiuxprocedure of Politano-Leadbetter technic and the other one was Paquin technic. 3. Mean duration of keeping splint catheter was 11 days. 4. Temporary nephrostomy was performed in 4 cases due to poor renal function. 5. Complications had been observed in 6 cases, which included septicemia, ureteral stricture, uremia, urineleakage and urinary infection.

Ureteral Tailoring and Anti-reflux Procedure in 6 Cases / 대한비뇨기과학회지

A clinical observation on ureteral tailoring with anti-reflux procedure on 6 ureters of 5 patients were reported herein. Four ureters of 3 children were hydroureteronephrosis with vesicoureteral reflux due to bladder neck contracture. Two ureters of housewives were megaloureter. The results of 5 cases were summarized as follows: 1. The length of tailoring was 8 cm. in average. 2. Tailored ureters were approximated by continuous suture plus simple sutures in 2 ureters of 1 case, everting plus simple sutures in 3 cases and the other was by everting sutures alone. No difference in methods of approximation was found in result. 3. All cases had undergone antireflux procedures. Five ureters of 4 cases were done by Politano-Leadbetter technic and the other one by Paquin technic. 4. Mean duration of splinting was some 2 weeks. We believe that splinting is essential for more than 10 days. 5. One case was died of septicemia on 7th postoperative day. Another case shows only unsterile urine yet. Satisfactory results were obtained from remaining 3 cases.