Related Experiment Video
Updated: Sep 25, 2026
Urethral Stricture Induction Followed by Buccal Mucosa Graft Urethroplasty in a Rat Model
Published on: April 28, 2023
The long-term outcome of bilateral Cohen ureteric reimplantation under a common submucosal tunnel
P A Androulakakis1, A A Stefanidis, D K Karamanolakis
1Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece.
Insights
Bilateral Cohen reimplantation using a common submucosal tunnel is highly effective for treating vesico-ureteric reflux (VUR) and obstructive megaureter in children. This reliable technique shows excellent long-term success rates with minimal complications.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Urologic Oncology
Background:
- Vesico-ureteric reflux (VUR) and obstructive megaureter are common conditions in children requiring surgical intervention.
- The Cohen reimplantation technique is a standard surgical approach for these conditions.
- Optimizing surgical outcomes and minimizing complications are crucial in pediatric urology.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of bilateral ureteric reimplantation using a common submucosal tunnel.
- To assess the outcomes of the modified Cohen technique in treating primary VUR and obstructive megaureter in children.
- To determine if crossing ureters within the tunnel impacts long-term obstruction.
Main Methods:
- Retrospective analysis of 102 children undergoing bilateral antireflux ureteric reimplantation between 1983 and 2000.
- Utilized a modified Cohen technique with both ureters placed under a common submucosal tunnel.
- Follow-up duration averaged 10.6 years (range 2-18 years).
Main Results:
- Successful treatment in 198 out of 204 (97%) ureters.
- One case of ureteric stenosis successfully re-operated.
- Transient edema, spontaneous reflux resolution, and one case of acute obstruction due to a narrow tunnel were managed successfully.
- No voiding dysfunction observed in school-aged patients.
Conclusions:
- The modified bilateral Cohen reimplantation with a common submucosal tunnel provides excellent long-term results for VUR and obstructive megaureter.
- Crossing ureters within the tunnel does not lead to long-term obstruction.
- This technique is recommended as a reliable surgical option for bilateral VUR or obstructive megaureter in children.
Objective:
To analyse the results of bilateral Cohen reimplantation under a common submucosal tunnel, over an 18-year period.
Patients And Methods:
We retrospectively examined 102 children (35 boys and 67 girls, median age 5.5 years, range 0.5-13.5) who underwent bilateral antireflux ureteric reimplantation from 1983 to 2000 with a modified Cohen technique, re-implanting both ureters under a common submucosal tunnel in the mid-trigonal area, to treat primary vesico-ureteric reflux (VUR, 99 patients) or obstructive megaureter (three). The mean (range) follow-up was 10.6 (2-18) years.
Results:
The operation was successful in 198 of 204 (97%) ureters. One patient had vesico-ureteric stenosis in one ureter and was re-operated successfully. In two ureters in two different patients there was transient stasis after surgery caused by oedema within the tunnel, which gradually resolved. Two ureters in two other patients had reflux after surgery, which resolved spontaneously after 12 and 24 months, respectively. A 6-month old baby had anuria after surgery because of acute compression of both ureters within a narrow tunnel; this patient was re-operated, the tunnel widened and the obstruction resolved. None of 82 patients who had reached school age by the time of their last follow-up showed signs of voiding dysfunction.
Conclusions:
The modified bilateral Cohen reimplantation with both ureters under a common submucosal tunnel offers very good long-term results in curing VUR or obstructive megaureter. Crossing one ureter upon the other within the tunnel does not predispose to long-term obstruction. From these results we recommend it as a reliable technique for surgically treating bilateral VUR or obstructive megaureter.
