Pneumovesicoscopic ureteral reimplantation with intravesical tailoring of obstructive megaureter in pediatric patient

  • Yu.E. Rudin
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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  • D.V. Marukhnenko
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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  • D.A. Galitskaya
    Correspondence
    Correspondience to: D.A. Galitskaya, 3d Parkovayast., bld. 51-1, Moscow, 105425, Russia
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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  • J.K. Aliev
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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  • G.V. Lagutin
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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  • A.B. Vardak
    Affiliations
    N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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Published:December 10, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.004

      Summary

      Introduction

      According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with ex vivo tailoring in children.

      An objective

      To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children.

      Study design

      Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25 mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star).

      Results

      43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142 min (83–235 min). The mean manipulation time for intravesical tailoring of the megaureter was 18 min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1–3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful.

      Discussion

      This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period.

      Conclusions

      Summary Figure
      Graphical AbstractThe technique of intravesical tailoring of the dilated ureter: a,d –schemes. b,c,e,f-intraoperation views.

      Keywords

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