[Cohen's uretero-vesical reimplantation in the treatment of primary obstructive mega-ureter]

The usual surgical treatment of primary obstructive megaureter consists of ureteral tailoring, according to H. Hendren's procedure, and reimplantation using Politano-Leadbetter technique. The Authors report their experience with trans-trigonal reimplantation (Cohen's ureteroneocystostomy) in case of primary obstructive megaureter. This procedure has been performed either in case of tailored megaureters than in those in which ureteral tailoring was not necessary. Considering its easy handling and safety, Cohen's technique has been indicated as method of choice for ureteral reimplantation even in case of primary obstructive megaureter, basing on successful experience on the treatment of vesicoureteral reflux. A current objection to the trans-trigonal technique for obstructive megaureter is the possibility of a postoperative reflux in the reimplanted megaureter (tailored or not), because of the difficulty in obtaining an adequate submucosal tunnel (unbalanced length/width ratio). The Authors report a 3 year experience on a common surgical treatment of primary obstructive megaureter. 56 cases were treated (bilateral megaureter in 3 cases) by trans-trigonal reimplantation (Cohen's ureteroneocystostomy) in addition to ureteral tailoring (Hendren's technique) in 46 cases or Kalicinski plication in 6. Finally, in 4 cases no tailoring procedure was needed (simple excision of the restricted terminal ureter). No postoperative complications nor cystographic evidence of postoperative reflux have been recorded in all cases (follow-up = 6-36 months), remarking this technique as safe and effective.