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[Variant of vesico-ureteral reflux surgical treatment in children]
Insights
Cowen
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Vesicoureteral reflux (VUR) affects numerous children, necessitating effective surgical interventions.
- Cowen's operation is a recognized surgical technique for managing VUR.
Observation:
- The study evaluated Cowen's operation on 77 ureters in 52 children with moderate to severe VUR (Grade II-IV).
- A modified technique, introduced in 1995, was applied to 18 ureters in 12 children with specific anatomical challenges.
Findings:
- The original Cowen's operation achieved a 97.7% success rate in treating VUR.
- The 1995 modification demonstrated a 100% success rate, particularly in cases with lateral ectopy of the ureteral orifice.
- This modification involves creating a submucosal tunnel at an acute vertical angle within the bladder, optimizing anatomical repositioning.
Implications:
- The modified Cowen's operation offers a highly effective and pathogenetically sound approach to VUR treatment.
- This surgical refinement enhances the anatomical integrity of the vesicoureteral junction, potentially reducing recurrence rates.
- The technique provides a valuable option for complex VUR cases, improving patient outcomes.
Abstract:
Cowen's operation has been performed on 77 ureters in 52 children with vesicoureteral reflux of degree II-IV. Positive results were observed in 97.7% of the operated children. These figures rose to 100% after Cowen's operation in original modification proposed by the authors in 1995. A total of 12 children (18 ureters) were treated according to this modification which, in pronounced lateral ectopy of the refluxing ostium ureteris, stipulates establishment of the cross-sectional tunnel not along the interureteral ligament, but at the acute vertical angle. The ostium of the reimplanted ureter was located under the contralateral one within the Lieutaud's triangle. In bilateral operation, one of the submucous tunnels is located along the upper line of the Lieutaud's triangle, the lower one being at the acute vertical angle. The above modification is pathogenetically sound and provides the unity of the anatomomorphological structures of the vesicoureteral segment.