Purpose: To describe a modified ureteral orthotopic reimplantation method in infant with primary obstructive megaureter (POM) and report our initial experience.
Methods: Thirteen children with POM (range 1-7 months) underwent modified transvesical ureteral implantation surgery. Treatment consists of transecting the ureter proximal to the obstruction and performing orthotopic reimplantation in end freely fashion with distal ureter protruding into the bladder, providing dilated ureteral diameter: ureteral exposure length in bladder ratio of 1:1.5-2. All patients underwent repeat ultrasound, radionuclide imaging and voiding cystourethrography. Cystoscopy was conducted in patients at 6 months after surgery.
Results: The mean operating time was 40 min. There were one redo this procedure for recurrent obstruction and one Cohen reimplantation for Grade 5 vesico-ureteral reflux in one bilateral POM. Hydroureteronephrosis improved in other 11 patients, and the ureter diameter was significantly reduced from preoperative measurements. At the time of cystoscopy, thick and large volcanic-shaped ureteral orifice was found and urine ejected intermittently.
Conclusions: The proposed 'modified ureteral orthotopic reimplantation' with no tapering or advancement for POM in infants is a simple, feasible and less invasive procedure that had good success rates in this small series. Further, larger studies are required to support or negate the usefulness of this technique.
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