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[Extravesicle ureterocystoanastomosis]
Insights
Extravesical ureterocystoanastomosis offers a promising surgical approach for vesicoureteral reflux and ureteral obstruction. This technique reduces operative injury and shows feasibility in complex cases, including reoperations.
Area of Science:
- Urology
- Surgical Innovation
Context:
- Extravesical ureterocystoanastomosis has been performed since 1986.
- The study included 79 patients (71 children, 8 adults).
- 112 ureters were treated for vesicoureteral reflux and supravesical ureteral obstruction.
Purpose:
- To evaluate the efficacy and outcomes of extravesical ureterocystoanastomosis.
- To assess the technique's applicability in primary and reoperative settings.
Summary:
- The procedure was performed on 79 patients with vesicoureteral reflux and ureteral obstruction.
- A 7.6% incidence of postoperative acute pyelonephritis was observed, with successful management through reoperation or nephrostoma removal.
- The technique demonstrated effectiveness in a complex case of recurrent vesicoureteral reflux after multiple prior surgeries.
Impact:
- Extravesical ureterocystoanastomosis presents reduced operative injury.
- It has no contraindications for primary operations or reoperations.
- The technique is feasible for various forms of ureterocystoanastomosis failure, indicating its promising potential.
Abstract:
Extravesical ureterocystoanastomosis without wide opening of the urinary bladder was practised since 1986. A total of 79 patients were operated: 71 children at the age from 1 to 14 years and 8 adults aged 14 to 58 years. Surgical intervention was performed on 112 ureters for vesicoureteral reflux and supravesical ureteral obstruction. 6 of 79(7.6%) patients on postoperative day 11-15 after removal of intubating drains had an attack of acute pyelonephritis. 3 of these 6 patients were reoperated with a good effect, in 2 patients urine passage recovered 2-3 months after removal of transcutaneous puncture nephrostoma. In one child this technique was used for the first time at the third operation on vesicoureteral anastomosis. This prevented subsequent removal of the nephrostomic drain because of vesicoureteral reflux in the presence of severe irreversible retention changes of both ureters. The advantages of the above technique are reduced operative injury, no contraindications in primary operations and reoperations, feasibility in various forms of vesicoureteral anastomosis failure. This makes the technique of extravesical ureterocystoanastomosis rather promising.