Use of Urethral Sound to Facilitate Locating Retrovesical Ureter for Politano-Leadbetter Pneumovesicoscopic Ureteral Reimplantation.

Xiang Zhao,Qingqing Tian,Erhu Fang,Ning Li

doi:10.3389/fped.2022.834465

Abstract

BackgroundPneumovesicoscopic ureteral reimplantation (PVUR) has gained popularity due to its minimal invasiveness. However, most of the reported PVUR procedures were based on the Cohen technique. Only few studies reported their experience of PVUR using the Politano-Leadbetter technique (PVUR-PL). Here, we reported our experience of PVUR-PL using a novel technique to facilitate locating the retrovesical ureter during the procedure.Materials and MethodsThe medical records of the patients who underwent PVUR-PL between January 2018 and December 2020 in our institution were retrospectively reviewed. The patients were classified into two groups: the modified group that accepted PVUR-PL using our novel technique (using urethral sound to facilitate identifying the retrovesical ureter) and the traditional group that accepted PVUR-PL not using the novel technique. Clinical data were collected retrospectively.ResultsThere were 22 patients who underwent PVUR-PL, with 13 in the traditional group and nine in the modified group. The mean operating time for unilateral cases in the modified group was significantly shorter than that in the traditional group (154.5 vs. 195.5 min, p < 0.001). For bilateral cases, the mean operating time was also significantly reduced (from 263.0 to 221.3 min, p = 0.022) in the modified group. There were no severe complications in each of the two groups. The peritoneum was perforated in one case from the traditional group, while no peritoneum perforation occurred in the modified group.ConclusionThe use of urethral sound to help to identify the retrovesical ureter during PVUR-PL is a safe and effective technique. This simple but effective technique could shorten the operating time of PVUR-PL and reduce the risk of peritoneum perforation.

Highlights

With the development of minimally invasive techniques, traditional open surgery is challenged by laparoscopic or endoscopic procedures
We reported our experience of Pneumovesicoscopic ureteral reimplantation (PVUR)-PL and introduce a simple but effective novel technique to further simplify the procedure of PVUR using PolitanoLeadbetter technique (PVUR-PL)
By uplifting the end of the sound, the proximal ureter and the superjacent bladder wall will protrude into the bladder cavity, and it will be very easy to open the new hiatus and identify the retrovesical ureter

Summary

Introduction

With the development of minimally invasive techniques, traditional open surgery is challenged by laparoscopic or endoscopic procedures. Ureteral reimplantation, which is usually recommended for patients with ureterovesical junction obstruction (UVJO) or severe vesicoureteral reflux (VUR), is gradually replaced by laparoscopic procedures [1–4]. A small portion of VUR or UVJO patients initially treated with endoscopic procedures still need secondary ureteral reimplantation [5–7]. Ureteral reimplantation is still the most popular treatment option for VUJO or VUR around the world [8]. Pneumovesicoscopic ureteral reimplantation (PVUR) has gained popularity due to its minimal invasiveness. Most of the reported PVUR procedures were based on the Cohen technique. Few studies reported their experience of PVUR using the Politano-Leadbetter technique (PVUR-PL). We reported our experience of PVUR-PL using a novel technique to facilitate locating the retrovesical ureter during the procedure

Methods

Results

Discussion

Conclusion