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A modified technique to correct primary vesicoureteral reflux in children
1Section of Pediatric Surgery, Veterans General Hospital-Taipei, National Yangming University, Taiwan, Republic of China.
Insights
This modified surgical technique effectively corrected primary vesicoureteral reflux in children, minimizing risks like orifice stenosis and obstruction. Long-term follow-up confirmed its high success rate in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reflux Management
Background:
- Primary vesicoureteral reflux (VUR) is a common condition in children.
- VUR can lead to recurrent urinary tract infections and renal scarring.
- Existing surgical techniques carry risks such as orifice stenosis.
Purpose of the Study:
- To describe a modified surgical technique for correcting primary VUR in children.
- To evaluate the efficacy and safety of this novel approach.
Main Methods:
- A modified technique involving bladder incision, ureteral mobilization, and layered closure was performed on 20 children (28 renal units) with grade III-IV VUR.
- The procedure involved freeing 2-3 cm of the extravesical ureter and pulling it into the bladder.
- Bladder muscle and mucosa were closed around the ureter.
Main Results:
- The technique demonstrated a high success rate, with only one patient experiencing residual reflux.
- Follow-up (14-42 months) using sonography and voiding cystourethrogram showed no recurrent reflux or urinary tract obstruction in the remaining patients.
- The procedure was well-tolerated, with no major complications reported.
Conclusions:
- This modified technique offers advantages including minimized risk of orifice stenosis and preservation of the ureteral orifice anatomy.
- It avoids pelvic dissection, simplifying the surgical procedure.
- The technique may not be suitable for severe hydroureter cases.
Purpose:
The authors describe the experience of a modified technique to correct primary vesicoureteral reflux in children.
Methods:
Twenty children (28 renal units) with primary vesicoureteral reflux (grade III to grade IV) were treated with this technique. The authors incised the bladder mucosa and muscle along the direction of the ureter using a right-angled probe as a guide. About 2 to 3 cm of extravesical ureter was freed and pulled into the bladder via the incision. The bladder muscle was closed under the ureter, and the mucosa was repaired over the ureter.
Results:
One patient had residual reflux. All other patients, who underwent follow-up with sonogram and voiding cystourethrogram from 14 to 42 months after the operation, had neither recurrent reflux nor urinary tract obstruction.
Conclusions:
The advantages of this technique are (1) anastomosis of the ureteral orifice to the urinary bladder is not needed, so that the risk of orifice stenosis is minimized; (2) the ureteral orifice remains unchanged after the procedure, so that ureteroscopic procedures are easier to perform in future if required; and (3) pelvic dissection is not needed as in extravesical detrusorrhaphy. However, this procedure may not be suitable for patients with severe hydroureter.