Laparoscopic Extravesical Ureteral Reimplantation for Correction of Primary and Secondary Megaureters: Preliminary Report of a New Simplified Technique
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In brief
In brief
This prospective study describes a simplified laparoscopic extravesical technique for treating obstructed megaureters in children. Six patients underwent the procedure with successful resolution of hydronephrosis and obstruction, demonstrating the technique's safety and reproducibility with short-term follow-up.
Written by the GCMD Library team from the article.
Purpose
To describe a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR) and evaluate the short-term outcomes.
Methods
Prospective study of children with primary and secondary megaureters treated at our institution between 2016 and 2018 by LEUR. A transperitoneal approach was used in all cases. The distal ureter was transected at the level of the stenosis. Detrusor muscle fibers were divided to expose bladder mucosa. The distal ureter was introduced into the bladder to create a valve-like mechanism. The ureter was fixed to the bladder mucosa by four stitches. We analyzed indications for surgery, complications and outcomes. Definition of success was relieved of obstruction and absence of VUR.
Results
Six patients with a mean age of 28.83 months (SD: 21.4) underwent LEUR. Indications for surgery were: infection [2], obstruction [2], decrease in renal differential function [1] and increase in hydronephrosis [1]. There were no intraoperative complications. Resolution of hydronephrosis, obstruction and VUR was achieved in all cases. Mean follow-up was 13 months (SD: 6.67).
Conclusion
LEUR for the correction of primary and secondary megaureters by this new technique is safe. The most important advantage is that this technique is simpler and more easily reproducible than conventional LEUR. However, long-term follow-up is required.
Type of study
Prospective, observational.
Level of evidence
Level III.