Pneumovesicoscopic modified orthotopic nipple ureteral reimplantation

Abstract

Objective To introduce pneumovesicoscopic orthotopic modified nipple ureteral reimplantation for megaureter and to compare its safety, feasibility and application with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation. Methods From January 2010 to March 2019, retrospective analysis was performed for clinical data of retrograde cystography and complications during pneumovesicoscopic orthotopic modified nipple ureteral reimplantation.The potential advantages and disadvantages were compared with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation.One hundred and seventy-nine cases were reviewed and analyzed in 3 groups.In open group, there were 44 boys and 19 girls.The age was under 6 months (n=32), 6 months to 1 year (n=23) and older than 1 year (n=8). The sideness was left (n=30), right (n=17) and bilateral (n=16). There were primary obstructive megaureter (POM, n=58), vesicoureteral reflux (VUR, n=4) and POM & VUR (n=1). And the outcomes were hydronephrosis (n=53), infection (n=33), ectopic ureteral orifice (n=7) and ureter cyst (n=3); In pneumovesicoscopic Cohen group, there were 38 boys and 17 girls.The age was under 6 months (n=10), 6 months to 1 year (n=5) and above 1 year (n=40). The sideness was left (n=27), right (n=13) and bilateral (n=15). There were POM (n=50), VUR (n=3) and POM & VUR (n=2). And the outcomes were hydronephrosis (n=44), infection (n=38), ectopic ureteral orifice (n=2) and ureter cyst (n=3); In pneumovesicoscopic modified nipple group, there were 36 boys and 25 girls.The age was under 6 months (n=22), 6 months to 1 year (n=28) and older than 1 year (n=11). The sideness was left (n=33), right (n=19) and bilateral (n=9). There were POM (n=50), VUR (n=7) and POM & VUR (n=4). And the outcomes were hydronephrosis (n=61), infection (n=56), ectopic ureteral orifice (n=3) and ureteral caecum (n=1). Results All cases of ureteral reimplantation were performed successfully.Pneumovesicoscopic operations were performed with only 2 cases of Cohen procedure converting into open surgery.No significant differences existed between pneumovesicoscopic Cohen procedure and pneumovesicoscopic orthotopic modified nipple procedure in operative duration (97.2±49.4 vs 77.4±37.0 min, P>0.05), volume of blood loss (3.7±1.5 vs 2.9±1.8 ml, P>0.05) and hospitalization stay (6.8±2.3 vs 6.2±1.3 days, P>0.05) with an equivalent postoperative antireflux efficacy and without severe complications.As compared with open surgery, pneumovesicoscopy offered longer operative duration (P<0.05), less volume of blood loss (P<0.05), shorter hospitalization stay (P<0.05) and fewer complications. Conclusions Pneumovesicoscopic orthotopic modified nipple ureteral reimplantation is an anatomic orthotopic ureteral reimplantation with remarkable antireflux and clinical efficacies.It is an alternative treatment for refluxing and obstructed megaureter. Key words: Child; Ureteral obstruction; Laparoscopes; Ureteral reimplantation