Paediatric transvesicoscopic Cohen ureteric reimplantation for ectopic upper ureter in duplication anomalies

Abstract

To evaluate the clinical outcomes of transvesicoscopic Cohen ureteric reimplantation for patients with ectopic upper pole ureters in duplication anomalies. Between July 2015 and January 2019, laparoscopic transvesicoscopic ureteral reimplantation was performed in 20 patients with ectopic upper pole ureters. An incision was made in the superior bladder wall at 1.0cm proximal to the lower ureteral orifice of affected side with an electric hook. The upper pole ureter has been recognized, and the terminal portion of the upper ureter was ligated and cut. Then the proximal portion of the upper ureter was mobilized, a transverse submucosal tunnel is created and ureteric reimplantation performed with 6/0 absorbable sutures. Patients were followed up with renal ultrasonography and voiding cystourethrogram. All of the 20 operations were successful, and none required conversion to an extravesical approach or open surgery. The operation time ranged from 90 to 155 minutes. Resolution of symptoms was achieved in all patients and VUR of the upper and lower ureters was not detected at postoperative follow-up. Four patients presented with temporary ureteric dilatation on follow-up renal ultrasound but recovered three months after operation. The laparoscopic intravesical technique of ureteral reimplantation was safe and feasible in our cases and may be an alternative surgical treatment for ectopic upper pole ureters in duplication anomalies.