Modified gas bladder laparoscopic Cohen ureteral replantation for terminal ureteral stenosis

Abstract

Objective To evaluate the clinical efficacy of modified air bladder laparoscope with Cohen ureteral replantation for terminal ureteral stenosis. Methods From January 2018 to May 2019, retrospective analysis was performed for 12 children with terminal ureteral stenosis undergoing modified gas bladder laparoscopic Cohen ureteral retransplantation. There were 8 boys and 4 girls with an average age of (3.0±2.2)(1.2-9.5) years. The involved side was left (n=9) and right (n=3). Ureteral stent was inserted into ostium ureteris via transurethral route after gas bladder creating. Ureteral stricture was resected. After transurethral replacement of stent tube, the silicone tube for chemotherapy was implanted at the involved ureteral side. The ends of stent and silicone tubes were sutured with traction. With precision cutting and forming, double J tube core was placed for Cohen ureteral reimplantation. After operation, urine routine, ultrasound of urinary system, excretive cystourethrography (VCUG), magnetic resonance urography (MRU), diuretic nephrogram and static renal imaging were performed regularly for evaluating such parameters as hydronephrosis, ureteral dilatation or stenosis, ureteral reflux and renal function. Results All 12 cases were successfully operated without switching into open surgery. The average operative duration was (99.0±16.1)(75-125) min, the average indwelling period of catheter (7.0±1.5)(5-10) days, the average indwelling period of bladder fistula (12.3±1.3)(10-14) days, the average postoperative hospital stay (9.5±2.8)(6-15) days and the average postoperative follow-up period (10.4±2.8)(6-16) months. At Month 6 postoperatively, renal pelvic anterioposterior diameter [(0.49±0.21) vs (1.35±0.32)cm]and maximal ureteral diameter [(0.66±0.21) vs (1.77±0.33) cm]of the involved side shrank markedly as compared with pre-operation. The differences were statistically significant (P<0.05). Renal static imaging indicated higher or unchanged renal function of the involved side. Diuretic renography revealed no mechanical obstruction curve, no back pain or urinary tract infections. One case of degree I reflux resolved after conservative measures. None was reoperated. Conclusions Modified gas bladder laparoscopic Cohen ureteral replantation is both safe and effective for ureteral terminal stenosis. It may simplify surgical procedures, shorten operative duration and recover quickly postoperatively. Key words: Child; Laparoscopes; Terminal ureteral stricture; Ureteral reimplantation