Sang Woon Kim1, Neddy Lee Lim1, Yong Seung Lee1, Sang Won Han1, Young Jae Im2. 1. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea. 2. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: YJIM@yuhs.ac.
Abstract
INTRODUCTION: To demonstrate the novel technique of laparoscopic intravesical detrusorrhaphy with ureteral plication for megaureter. TECHNICAL CONSIDERATIONS: From December 2012 to June 2014, 11 patients with primary unilateral megaureter underwent laparoscopic intravesical detrusorrhaphy with ureteral plication. By a transvesicoscopic approach using a 3-port technique, the ureter was mobilized and plicated with a 6F Foley catheter. After dissection of the bladder mucosa in a semilunar shape, the detrusor was incised vertically and repaired underneath the mobilized ureter to create a submucosal tunnel. The ureter was covered with bladder mucosa, and the ureteral orifice was anastomosed to its orthotopic neoureteric orifice. The mean age of the included patients at the time of surgery was 9.18 years (range, 12 months-24 years). All surgeries were successfully completed without open conversion, with a mean operation time of 214 minutes including preoperative evaluation. All patients tolerated the procedure without any complications. Within the mean follow-up duration of 12.6 months (range, 5-24 months), no complications related to the surgery were reported, and no vesicoureteral reflux was detected in the operated side on postoperative voiding cystourethrography. The distal ureteral diameter was significantly reduced (from 21.1 to 11.6 mm), and the grade of hydronephrosis was decreased on postoperative ultrasonography without deterioration of renal function. CONCLUSION: In this study, laparoscopic intravesical detrusorrhaphy with ureteral plication demonstrated successful short-term outcomes in management of megaureter in children and adults. Our technique can be an effective and feasible surgical option in the treatment of megaureter.
INTRODUCTION: To demonstrate the novel technique of laparoscopic intravesical detrusorrhaphy with ureteral plication for megaureter. TECHNICAL CONSIDERATIONS: From December 2012 to June 2014, 11 patients with primary unilateral megaureter underwent laparoscopic intravesical detrusorrhaphy with ureteral plication. By a transvesicoscopic approach using a 3-port technique, the ureter was mobilized and plicated with a 6F Foley catheter. After dissection of the bladder mucosa in a semilunar shape, the detrusor was incised vertically and repaired underneath the mobilized ureter to create a submucosal tunnel. The ureter was covered with bladder mucosa, and the ureteral orifice was anastomosed to its orthotopic neoureteric orifice. The mean age of the included patients at the time of surgery was 9.18 years (range, 12 months-24 years). All surgeries were successfully completed without open conversion, with a mean operation time of 214 minutes including preoperative evaluation. All patients tolerated the procedure without any complications. Within the mean follow-up duration of 12.6 months (range, 5-24 months), no complications related to the surgery were reported, and no vesicoureteral reflux was detected in the operated side on postoperative voiding cystourethrography. The distal ureteral diameter was significantly reduced (from 21.1 to 11.6 mm), and the grade of hydronephrosis was decreased on postoperative ultrasonography without deterioration of renal function. CONCLUSION: In this study, laparoscopic intravesical detrusorrhaphy with ureteral plication demonstrated successful short-term outcomes in management of megaureter in children and adults. Our technique can be an effective and feasible surgical option in the treatment of megaureter.