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Nhungo CJ, Mwakalukwa KR, Wambura EP, Kibona HG, Mushi FA, Msangi NS, Maro IM, Kimu NM, Nyongole OV, Mkony CA. Surgical management of high-grade vesicoureteral reflux in an 18-month-old female with a solitary kidney: A case report from a resource-limited setting. Clin Case Rep 2024; 12:e9132. [PMID: 38966288 PMCID: PMC11222966 DOI: 10.1002/ccr3.9132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024] Open
Abstract
Key Clinical Message Conservative nonsurgical therapy ensures that the resolution is nearly 80% for vesicoureteral reflux grades I and II and 30%-50% for vesicoureteral reflux grades III and V within 4-5 years of follow-up. Open surgical reimplantation of ureters of grades IV and V is a highly successful procedure, with reported correction rates ranging from 95% to 99% regardless of the severity of vesicoureteral reflux. Abstract Patients with vesicoureteral reflux present with a wide range of severity. With an incidence of approximately 1%, vesicoureteral reflux is a relatively common urological abnormality in children. Postnatal diagnosis of vesicoureteral reflux is typically made following a diagnosis of a urinary tract infection and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing vesicoureteral reflux. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessments and prompt decision-making. Surgical correction is advised for patients with vesicoureteral reflux grades IV and V, while vesicoureteral reflux grades I, II, and III are managed conservatively.
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Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Kelvin Richard Mwakalukwa
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Erasto Phares Wambura
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | | | - Fransia Arda Mushi
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | | | | | - Njiku Marko Kimu
- Department of UrologyMuhimbili National HospitalDar es salaamTanzania
| | - Obadia Venance Nyongole
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Charles A. Mkony
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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Lopez M, Perez-Etchepare E, Bustangi N, Godik O, Juricic M, Varlet F, Gutierrez R, Gomez Culebras M, Gander R, Royo G, Asensio M. Laparoscopic Extravesical Reimplantation in Children with Primary Obstructive Megaureter. J Laparoendosc Adv Surg Tech A 2020. [PMID: 32212997 DOI: 10.1089/lap.2019.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Conservative management of primary obstructive megaureter (POM) appears as the best option in patients with adequate ureteral drainage. Nevertheless, surgical intervention is indicated in cases of recurrent urinary tract Infections (UTIs), deterioration of split renal function, and significant obstruction. The gold standard includes: Ureteral reimplantation with or without tapering by open approach. Our objective is to report our results in the treatment of POM by Laparoscopic-Assisted Extracorporeal Ureteral Tapering Repair (EUTR) and Laparoscopic Ureteral Extravesical Reimplantation (LUER) and to evaluate the efficacy and security of this procedure. Materials and Methods: From January 2011 to January 2018 a retrospective study was carried out by reviewing the clinical records of 26 patients diagnosed with POM. All patients underwent laparoscopic ureteral reimplantation following Lich Gregoir technique. In cases of ureteral tapering, an EUTR was performed with Hendren technique. Results: In all patients LUER and EUTR were performed without conversion. No ureteral tapering was necessary in six patients. There were no intraoperative complications. At 3 months in postoperative, 1 patient presented a febrile UTI, and subsequently, a vesicoureteral reflux (VUR) grade III was diagnosed by voiding cystourethrogram. In this case, a redo laparoscopic surgery was performed. After long-term follow-up, all patients were asymptomatic without recurrence of POM or VUR. Conclusion: Laparoscopic-assisted EUTR and LUER following Lich Gregoir technique for POM constitutes a safe and effective option, with a success rate similar to that of open procedure. Nevertheless, larger randomized prospective trials and long-term follow-up are required to validate this technique.
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Affiliation(s)
- Manuel Lopez
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain.,Department of Pediatric Surgery & Urology, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Eduardo Perez-Etchepare
- Department of Pediatric Surgery & Urology, University Hospital Nuestra Senora de Candelaria, Tenerife, Spain
| | - Nasser Bustangi
- Department of Pediatric Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Oleg Godik
- Department of Pediatric Surgery & Urology, National Medical University and Clinic Oberig, Kiev, Ukraine
| | - Michel Juricic
- Service de Chirurgie Pédiatrique et Urologie Toulouse, Clinique Rive du Gauche, Toulouse, France
| | - Francois Varlet
- Department of Pediatric Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - Rocio Gutierrez
- Department of Pediatric Surgery, University Hospital of Arnaud de Villanova, Lleida, Spain
| | - Mario Gomez Culebras
- Department of Pediatric Surgery & Urology, University Hospital Nuestra Senora de Candelaria, Tenerife, Spain
| | - Romy Gander
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Gloria Royo
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Marino Asensio
- Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
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Lopez M, Gander R, Royo G, Varlet F, Asensio M. Laparoscopic-Assisted Extravesical Ureteral Reimplantation and Extracorporeal Ureteral Tapering Repair for Primary Obstructive Megaureter in Children. J Laparoendosc Adv Surg Tech A 2017; 27:851-857. [DOI: 10.1089/lap.2016.0456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manuel Lopez
- Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Romy Gander
- Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Gloria Royo
- Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - François Varlet
- Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Marino Asensio
- Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron, Barcelona, Spain
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Mendichovszky I, Solar BT, Smeulders N, Easty M, Biassoni L. Nuclear Medicine in Pediatric Nephro-Urology: An Overview. Semin Nucl Med 2017; 47:204-228. [PMID: 28417852 DOI: 10.1053/j.semnuclmed.2016.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.
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Affiliation(s)
- Iosif Mendichovszky
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marina Easty
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Extravesical approach in paraureteral bladder diverticulum: a case report. W INDIAN MED J 2014; 63:201-3. [PMID: 25303263 DOI: 10.7727/wimj.2012.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/16/2012] [Indexed: 11/18/2022]
Abstract
Bladder diverticulaeare herniations of bladder mucosa through fibers of the detrusor muscle. We present the extravesical approach to a case of paraureteral bladder diverticulum in a six-year-old boy who had a history of recurrent urinary infection. In case of recurrent urinary complaints, the possibility of presence of a bladder diverticulum should be kept in mind. Voiding cystourethrogram is helpful for the differential diagnosis of the bladder diverticulum. Excision by extravesical approach of the paraureteral bladder diverticulum is a good choice.
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García-Aparicio L, Blázquez-Gómez E, Martin O, Palazón P, Manzanares A, García-Smith N, Bejarano M, de Haro I, Ribó JM. Use of high-pressure balloon dilatation of the ureterovesical junction instead of ureteral reimplantation to treat primary obstructive megaureter: is it justified? J Pediatr Urol 2013; 9:1229-33. [PMID: 23796389 DOI: 10.1016/j.jpurol.2013.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare outcomes between high-pressure balloon dilatation of the ureterovesical junction (UVJ) and ureteral reimplantation with ureteral tapering to treat primary obstructive megaureter (POM). PATIENTS AND METHODS Retrospective review of clinical data from patients who underwent surgical treatment of POM from 2005 to 2010. Patients were divided into two groups: endoscopic treatment (ET) with UVJ dilatation and ureteral reimplantation (UR) with Cohen's or Leadbetter-Politano neoureterocystostomy and Hendren's tapering. Preoperative studies included ultrasound scan (US), voiding cystourethrography, and diuretic isotopic renogram. Outcome parameters were US, differential renal function (DRF), presence of postoperative vesicoureteral reflux, need for secondary reimplantation and complications. RESULTS ET 13 patients with a median age of 7 (4-24) months; UR: 12 patients with a median age of 14 (7-84) months, with no statistical differences in age and gender between groups. Preoperative US parameters were similar. ET: mean diameter of renal pelvis, calices and ureter was 23.5 mm, 13.46 mm and 15.77 mm respectively. UR: mean diameter of renal pelvis, calices and ureter was 22.25 mm, 11.75 mm, and 19.08 mm, respectively. Preoperative DRF was 45.62% and 39.33% for ET and UR, respectively (p > 0.05). Significant improvement of hydroureteronephrosis was observed in 11/13 patients of ET and 11/12 patients of UR (p > 0.05). Postoperative DRF was 42% and 48% for ET and UR, respectively (p > 0.05). Postoperative vesicoureteral reflux was observed in 2 patients of ET and 1 of UR (p > 0.05). Secondary ureteral reimplantation was needed in 3 patients of ET and 2 of UR (p > 0.05). CONCLUSION Endoscopic treatment of POM is as effective as ureteral reimplantation but further randomized clinical trials are needed to support these results.
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Affiliation(s)
- L García-Aparicio
- Pediatric Urology, Pediatric Surgery Dept, Hospital Sant Joan de Déu, University of Barcelona, Spain.
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DeFoor W, Minevich E, Reddy P, Polsky E, McGregor A, Wacksman J, Sheldon C. RESULTS OF TAPERED URETERAL REIMPLANTATION FOR PRIMARY MEGAURETER: EXTRAVESICAL VERSUS INTRAVESICAL APPROACH. J Urol 2004; 172:1640-3; discussion 1643. [PMID: 15371780 DOI: 10.1097/01.ju.0000138529.43179.dd] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Extravesical ureteroneocystostomy is an accepted technique for the surgical treatment of vesicoureteral reflux. However, many surgeons continue to use an intravesical technique when extensive ureteral tailoring is required in the case of primary megaureter. We present our experience and outcomes with these techniques. MATERIALS AND METHODS A retrospective cohort study was performed of all patients who underwent tapered ureteral reimplantation between 1990 and 2002. Patient demographics, surgical technique and outcomes were recorded. Patients with ureteral dilatation secondary to bladder or urethral pathology were excluded from study. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux. RESULTS A total of 53 patients with 65 megaureters were identified. Mean patient age at surgery was 4.9 years and mean followup was 3.8 years. Primary obstructive megaureter was present in 31 renal units, while refluxing megaureter was present in 34. An excisional tapering technique was performed in all cases. An extravesical reimplantation was performed in 29 renal units and an intravesical reimplantation in 36. The success rate was 86% for intravesical and 76% for extravesical reimplantation. The success rate was 90% for obstructive megaureters and 74% for refluxing megaureters. Success rate for patients with voiding dysfunction was 93% with an intravesical approach but only 50% with an extravesical approach. CONCLUSIONS Extensive ureteral tailoring with an extravesical ureteral reimplantation may be performed safely and effectively for primary obstructive megaureter. Patients with voiding dysfunction or preoperative vesicoureteral reflux may benefit from an intravesical ureteral reimplantation.
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Affiliation(s)
- William DeFoor
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Perez-Brayfield M, Kirsch AJ, Hensle TW, Koyle MA, Furness P, Scherz HC. ENDOSCOPIC TREATMENT WITH DEXTRANOMER/HYALURONIC ACID FOR COMPLEX CASES OF VESICOURETERAL REFLUX. J Urol 2004; 172:1614-6. [PMID: 15371773 DOI: 10.1097/01.ju.0000139013.00908.1c] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The surgical correction of primary vesicoureteral reflux (VUR) is highly successful. This success decreases in more complex cases and often involves reoperation and increased morbidity. We present our experience with the use of subureteral injection of dextranomer/hyaluronic acid (Dx/HA) in complex cases of vesicoureteral reflux in which open surgery would have been indicated. MATERIALS AND METHODS Between October 2001 and July 2003, 72 patients 9 months to 31 years old (mean age 5.6 years) underwent subureteral injection of Dx/HA for complex VUR at our institutions. Dx/HA was injected submucosally within the intramural ureter (modified STING) in most cases. A guidewire was used to manipulate the ureteral orifice and a retrograde ureterogram was used to delineate the anatomy in selected cases. The average volume of injected material was measured for each ureter. Renal sonography was performed to determine if hydronephrosis was present. At 3 months fluoroscopic voiding cystourethrograms were used to evaluate for the presence of VUR. RESULTS A total of 93 ureters were treated in 55 girls and 17 boys. All cases were considered to be complex as 17 had persistent reflux after open surgery (7 megaureters repairs, 2 extravesical repairs, 7 intravesical reimplants and 1 blind ureter), 11 had persistent reflux and neurogenic bladder, 7 had ectopic ureters to bladder neck, 6 had bilateral Hutch diverticulum, 6 had persistent stump reflux, 5 had ureterocele after puncture or incision, 15 had duplications, 1 had the prune belly syndrome, 2 had posterior urethral valve following resection, 1 had epispadias and 1 had urogenital sinus. The average maximum reflux grade was IV. An average of 1.1 cc (range 0.4 to 2) was injected per ureter. Of the patients 69 had 3-month followup results. The overall success rate was 68% after 1 implantation (47 of 69). CONCLUSIONS Submucosal intraureteral implantation with Dx/HA corrected complex vesicoureteral reflux in 68% of patients. In all of these patients open surgery would have potentially been difficult. The use of fluoroscopy and/or guidewires is a useful adjunct in these cases. We believe that this minimally invasive approach is warranted as an initial step in the management of complex cases of VUR before resorting to more difficult open surgical procedures.
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Affiliation(s)
- Marcos Perez-Brayfield
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
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MINEVICH EUGENE, TACKETT LESLIE, WACKSMAN JEFFREY, SHELDON CURTISA. EXTRAVESICAL COMMON SHEATH DETRUSORRHAPHY (URETERONEOCYSTOTOMY) AND REFLUX IN DUPLICATED COLLECTING SYSTEMS. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65452-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- EUGENE MINEVICH
- From the Division of Pediatric Urology, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - LESLIE TACKETT
- From the Division of Pediatric Urology, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - JEFFREY WACKSMAN
- From the Division of Pediatric Urology, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - CURTIS A. SHELDON
- From the Division of Pediatric Urology, Children’s Hospital Medical Center, Cincinnati, Ohio
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EXTRAVESICAL COMMON SHEATH DETRUSORRHAPHY (URETERONEOCYSTOTOMY) AND REFLUX IN DUPLICATED COLLECTING SYSTEMS. J Urol 2002. [DOI: 10.1097/00005392-200201000-00085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INCIDENCE OF CONTRALATERAL VESICOURETERAL REFLUX FOLLOWING UNILATERAL EXTRAVESICAL DETRUSORRHAPHY (URETERONEOCYSTOSTOMY). J Urol 1998. [DOI: 10.1097/00005392-199806000-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Minevich E, Wacksman J, Lewis AG, Sheldon CA. Incidence of contralateral vesicoureteral reflux following unilateral extravesical detrusorrhaphy (ureteroneocystostomy). J Urol 1998; 159:2126-8. [PMID: 9598556 DOI: 10.1016/s0022-5347(01)63292-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The development of contralateral vesicoureteral reflux following different types of unilateral antireflux surgery has been reported to be as high as 22%. We review our recent experience with unilateral extravesical detrusorrhaphy in regard to the incidence of postoperative contralateral vesicoureteral reflux. MATERIALS AND METHODS Between 1990 and 1995, 72 children underwent unilateral extravesical detrusorrhaphy. Of 73 refluxing renal moieties (1 patient had reflux in both moieties of a completely duplicated kidney) reflux grade was II in 35 (48%), III in 25 (34%), IV in 11 (15%) and V in 2 (3%). Common sheath reimplantation for complete ipsilateral duplication was performed in 16 patients. RESULTS One patient had grade I postoperative ipsilateral vesicoureteral reflux resulting in a success rate of 98.6%. In 4 patients (5.6%) contralateral vesicoureteral reflux developed, and was grade II in 3 and grade I in 1. In all patients contralateral reflux resolved at 16, 17, 18 and 31 months of followup. No additional surgery was required in any patient. There was no association between the incidence of contralateral vesicoureteral reflux, and patient age, gender, preoperative ipsilateral reflux grade and presence of ipsilateral duplication. CONCLUSIONS Unilateral extravesical detrusorrhaphy is a highly successful procedure with a low incidence of postoperative contralateral vesicoureteral reflux. Should reflux develop, it is of low grade with a significant rate of spontaneous resolution.
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Affiliation(s)
- E Minevich
- Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA
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Jayanthi VR, McLorie GA, Khoury AE, Churchill BM. Extravesical detrusorrhaphy for refluxing ureters associated with paraureteral diverticula. Urology 1995; 45:664-6. [PMID: 7716849 DOI: 10.1016/s0090-4295(99)80060-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To demonstrate the effectiveness of an extravesical approach to refluxing ureters associated with paraureteral diverticula. METHODS Over a 39-month period, 23 children underwent repair of Hutch diverticula with refluxing ureters using an extravesical approach. Seventeen had unilateral reflux with an ipsilateral diverticulum, 4 had bilateral reflux with a unilateral diverticulum, and 2 had bilateral reflux with bilateral diverticula. Overall, 25 ureters with associated diverticula were repaired. RESULTS Twenty ureters were repaired with a nondismembered technique and 5 with a dismembered technique. Twenty-two of the 23 patients (96%) were successfully repaired with this approach. Three patients had transient reflux postoperatively, which resolved spontaneously within 6 months. One patient who underwent bilateral dismembered procedures for bilateral diverticula has persistent unilateral grade II reflux postoperatively. No patient developed ureteral obstruction. CONCLUSIONS The major advantage of this technique is seen in the minimal postoperative morbidity. The extravesical approach is a safe, simple, and effective method for the management of a refluxing ureter with an associated diverticulum.
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Affiliation(s)
- V R Jayanthi
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
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