Partial flap ureteroneocystostomy for bilharzial strictures of lower ureter

Suture-free technique of extravesical ureteroneocystostomy with ring pin stapler: experimental study of canines. I. Preliminary results

OBJECTIVES

To compare the mechanical and sutured ureteroneocystostomy in a canine model.

METHODS

In 18 dogs, extravesical ureteroneocystostomy on 1 side was randomly assigned to end-to-side anastomosis performed with a titanium ring-pin stapler or interrupted absorbable sutures. To create the antireflux tunnel, the longitudinal line of the muscle layer was closed over the implanted ureter with titanium clips or sutures. At 3 months postoperatively, renal ultrasonography, intravenous urography, ascending cystography, the Whitaker test, and the macroscopic and microscopic results were assessed.

RESULTS

The ureteroneocystostomy with the ring pin stapler and the antireflux tunnel construction with titanium clips had a 100% technical success rate. Compared with manual suturing anastomosis, the suture-free technique took a significantly shorter time and resulted in slightly, but not significantly, less ureteral obstruction after 3 months. One dog in group 2 had evidence of ureteral dilation and hydronephrosis compared with the normal contralateral side. No signs of stone formation, urinary cyst, or fistulas were found after either closure method. None of the 18 dogs demonstrated vesicoureteral reflux. Histologic examination showed no signs of acute inflammation or marked fibrosis in any of the 18 specimens. Moreover, the intrapelvic pressure in group 1 was approximately similar to that of the normal contralateral side.

CONCLUSIONS

Ureteroneocystostomy performed with a titanium ring-pin stapler is feasible and faster than using conventional sutures. This suture-free technique is simple and safe, with possibly lower complication rates than a nonstented suture technique. Additional studies with a longer follow-up duration are needed to confirm these results.

Urinary tract infections in children: treatment

Urinary tract infection is a frequent diagnosis in children who are referred to the urologist. Infections vary in scope and severity, warranting thoughtful consideration of appropriate therapy. Infections of the genitourinary system may include bacterial,viral, fungal, or parasitic microorganisms. Adequate therapy requires rapid detection and control of these conditions to prevent pyelonephritic renal scarring and its sequelae.

A novel technique of ureteroneocystostomy (extravesical seromuscular tunnel): a preliminary clinical study

OBJECTIVES

To present our initial clinical experience with the new technique of extravesical seromuscular tunnel ureteroneocystostomy.

METHODS

The technique was performed in 21 patients for different indications; the most common was unilateral bilharzial stricture of the lower end of the ureter. The patients were regularly seen every 3 months during the first year, every 6 months during the second year, and annually thereafter during a follow-up period of 24.2 +/- 10.2 months. A chemical profile, urine culture, and renal ultrasound scan were performed at every visit. A technetium-99m diethylenetriaminepentaacetic acid renal scan was carried out at least once every 12 months. Ascending cystography and intravenous urography were done at least once during the entire follow-up period.

RESULTS

The postoperative course was uneventful in all patients. Improvement in renal function was achieved in 16 patients and the remaining 5 experienced stabilization. Improvement of the configuration of the corresponding renoureteral unit was observed in all but 4 patients who had stabilization to almost that of the preoperative condition. None of the 21 patients demonstrated vesicoureteral reflux during the follow-up period.

CONCLUSIONS

The new technique of extravesical seromuscular tunnel is suitable for reimplantation of the dilated ureters. Other studies with a larger number of patients and a longer duration of follow-up are necessary to confirm these results.