Transvesicoscopic ureteral tapering for congenital megaureter

Abstract

The transvesicoscopic approach is a minimally invasive option with potential advantages (i.e., less pain, shorter duration of hospitalization, and improved cosmetic outcome). Transvesicoscopic surgeries have not been widely used owing to technical challenges, and its limited indication due to the small working space. Therefore, only few studies have investigated the use of transvesicoscopic ureteral tapering (TVUT) for the treatment of congenital megaureter. Herein, we present our experience with the use of TVUT. Four patients (three females and one males) underwent TVUT for congenital megaureter in Shiga University of Medical Science. Three of those presented with symptoms (i.e., flank pain and recurrent urinary tract infection), while the fourth patient presented with progression of reduced renal function. All patients underwent the Cohen procedure with excisional ureteral tapering. A traction suture was placed inside the incision line of the distal portion for sufficient mobilization of the ureter. After resection of the distal portion, an 8-Fr feeding tube was placed into the ureter through the urethra. In addition, another traction suture was placed at the end of the ureter to facilitate ureteral tailoring through traction adjustment. The lateral wall of the ureter was subsequently excised alongside the tube. After tapering, the side of the ureter was closed using a running suture. A ureteral stent was placed in the ureter after ureterovesical anastomosis. The ureteral stent was removed 4 weeks after surgery. All operations were successfully completed, and there was no requirement for open conversions or blood transfusions. The mean total operative time was 219 minutes (range: 156–279 min). Follow-up ultrasound test confirmed decreased hydronephrosis in all patients. Moreover, recurrent urinary tract infections resolved and flank pain was relieved. TVUT appears to be a feasible and effective option for the treatment of congenital megaureter.