Md Jafrul Hannan1. 1. Department of Pediatric Surgery, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh.
Abstract
BACKGROUND: Cutaneous ureterostomy is still practiced despite a trend towards primary surgical correction for obstructive or refluxive uropathy. For future open reimplantation, ureterostomy can be created by minimal invasive technique at the end(s) of the suprapubic creaseline. MATERIALS AND METHODS: From 1 January 2009 to 31 July 2012, seven children were treated with laparoscopy-assisted cutaneous ureterostomy followed by ureteric reimplantation. Indications were primary obstructive megaureter 3, hugely dilated ureters with reflux 3 and posterior urethral valve with poor general health 1. The distal manoeuverable part of tortuous ureter was pulled to the surface at either end of suprapubic creaseline to create the stoma. During reimplantation, this stoma was dismembered and brought inside urinary bladder obviating the need for stoma-site repair. RESULTS: Mean age was 4.6 ± 2.8 years with six males. There were three bilateral cases with total 10 lesions. Mean operating time was 39.8 ± 12.5 minutes. Mean follow-up was 1.7 ± 0.8 years and except for peri-stomal excoriations no major complication occurred. All these were reimplanted 6-12 months after ureterostomy and faring well except in one case. CONCLUSIONS: Laparoscopy-assisted cutaneous ureterostomy can be fashioned at suprapubic creaseline to facilitate future reimplantation without much jeopardy and extra scar.
BACKGROUND:Cutaneous ureterostomy is still practiced despite a trend towards primary surgical correction for obstructive or refluxive uropathy. For future open reimplantation, ureterostomy can be created by minimal invasive technique at the end(s) of the suprapubic creaseline. MATERIALS AND METHODS: From 1 January 2009 to 31 July 2012, seven children were treated with laparoscopy-assisted cutaneous ureterostomy followed by ureteric reimplantation. Indications were primary obstructive megaureter 3, hugely dilated ureters with reflux 3 and posterior urethral valve with poor general health 1. The distal manoeuverable part of tortuous ureter was pulled to the surface at either end of suprapubic creaseline to create the stoma. During reimplantation, this stoma was dismembered and brought inside urinary bladder obviating the need for stoma-site repair. RESULTS: Mean age was 4.6 ± 2.8 years with six males. There were three bilateral cases with total 10 lesions. Mean operating time was 39.8 ± 12.5 minutes. Mean follow-up was 1.7 ± 0.8 years and except for peri-stomal excoriations no major complication occurred. All these were reimplanted 6-12 months after ureterostomy and faring well except in one case. CONCLUSIONS: Laparoscopy-assisted cutaneous ureterostomy can be fashioned at suprapubic creaseline to facilitate future reimplantation without much jeopardy and extra scar.