Abstract
Purpose: To report our initial experience with a modified ureteral orthotopic reimplantation technique under pneumovesicum and compare the outcomes vs. those obtained with the Cohen technique under pneumovesicum for the correction of primary obstructive megaureter (POM) or vesicoureteral reflux(VUR) in pediatric patients.Methods: A total of 46 patients (38 POM and 8 VUR; mean age: 16.24 months) treated with modified ureteral orthotopic reimplantation (OR) and 43 patients (34 POM and 9 VUR; mean age: 22.98 months) treated with Cohen reimplantation (CR) under pneumovesicum were included. We compared the results perioperatively and during follow-up.Results: The mean operative time was significantly shorter in the OR group (OR: 86.86 and 108.18 vs. CR: 95.14 and 124.29 min for unilateral and bilateral cases, respectively). The mean postoperative hospital stay (OR: 5.02 vs. CR: 5.07 days), blood loss (OR: 3.67 vs. CR: 3.84 ml), and follow-up time (OR: 23.17 vs. CR: 23.37 months) did not exhibit significant differences between the two groups. One patient converted to open surgery in the CR group, whereas there was no conversion in the OR group. Postoperative febrile urinary tract infection occurred in two cases in each group. Both infections were controlled using antibiotics. All patients in both groups showed improved hydroureteronephrosis, and all patients with VUR showed reflux resolution post-surgery.Conclusions: Our modified ureteral orthotopic reimplantation technique under pneumovesicum can be safely and effectively performed, achieving a high success rate that is equivalent to that obtained through the Cohen technique under pneumovesicum. Moreover, it involves a simpler procedure and shorter operation time.
Highlights
Primary obstructive ureter (POM) and primary vesicoureteral reflux (VUR) are congenital malformations of the upper urinary tract in children
The operative time was significantly shorter in the orthotopic reimplantation (OR) group (OR: 86.86 ± 12.37 and 108.18 ± 15.70 min vs. Cohen reimplantation (CR): 95.14 ± 8.58 and 124.29 ± 13.97 min, for unilateral and bilateral cases, respectively; p < 0.05)
There was no significant difference in postoperative hospital stay (OR: 5.02 ± 0.88 vs. CR: 5.07 ± 0.99 days; p > 0.05) and volume of blood loss (OR: 3.67 ± 0.90 vs. CR: 3.84 ± 0.81 ml; p > 0.05)
Summary
Primary obstructive ureter (POM) and primary vesicoureteral reflux (VUR) are congenital malformations of the upper urinary tract in children. For POM or low-grade (grades I–II) VUR, the majority of cases resolve spontaneously or persist without deterioration of renal function and appearance of symptoms [4, 5]. Surgical intervention should be considered in patients with high-grade (grades IV–V) VUR [1] or those cases associated with urinary tract infection (UTI), increasing dilatation, and deteriorating renal function [2, 3]. Lengthening of the intramural part of the ureter by ureteral tapering and reimplantation is an established and reliable treatment for high-grade VUR and persistent POM. Performing classic reimplantation in the bladders of infants may be extremely challenging due to the limited bladder volume This procedure is linked to difficulty in endoscopically accessing the ureters in the future [6].
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