Catheter-less Cohen transtrigonal ureteric reimplantation

Area of Science:

• Pediatric Urology
• Surgical Innovation

Background:

• Ureteric reimplantation surgery is a common procedure for treating vesicoureteral reflux.
• Traditionally, bladder catheterization is used post-operatively to ensure bladder drainage and monitoring.
• The Cohen transtrigonal technique is a widely adopted method for ureteric reimplantation.

Purpose of the Study:

• To evaluate the safety and outcomes of a catheter-less approach in patients undergoing Cohen transtrigonal ureteric reimplantation.
• To assess the impact of omitting a bladder catheter on patient recovery and hospital stay.

Main Methods:

• A retrospective review of 37 patients who underwent Cohen transtrigonal ureteric reimplantation between April 2000 and April 2001.
• Implementation of a catheter-less protocol for 27 selected patients, with close post-operative monitoring.
• Pain management included caudal anesthesia, oral analgesia, and intravesical bupivacaine.

Main Results:

• Patients tolerated the absence of a bladder catheter well, with only one requiring post-operative catheterization.
• A significant reduction in hospital stay was observed, with some patients discharged on the day of surgery or the first post-operative day.
• 10 patients required a suprapubic catheter due to complex cases or insufficient development of the catheter-less technique at the time of surgery.

Conclusions:

• Omitting a bladder catheter during Cohen transtrigonal ureteric reimplantation is a safe and viable option.
• Selective use of a catheter-less approach can lead to decreased hospital stay and reduced patient discomfort.
• This strategy represents a potential improvement in post-operative management for pediatric urological surgery.