Laparoscopic pneumovesical ureteral tapering and reimplantation for megaureter

To evaluate the efficacy of laparoscopic pneumovesical ureter reimplantation for congenital malformation involving the vesicoureteral junction in children.

From January 2005 to October 2010, 45 cases (comprising 61 ureters) were diagnosed as megaureter caused by vesicoureteral junction obstruction. A pneumovesical laparoscopic Cohen procedure was performed in all cases. Twelve of the ureters underwent excisional ureteral tapering. Ureteral diameters were obtained using ultrasonography and were divided into 4 groups according to the degree of dilatation.

The procedure was completed in all but 2 patients, who were converted to open surgery. The mean operation time was 3.5h (range, 2-8h) for unilateral ureter cases, 3.7h (range, 3.5-4.5h) for duplicated ureter cases, and 5.4h (range, 3.5-9h) for bilateral cases. The mean duration of urethral catheter placement and hospital stay was 6.7 days (range, 3-14 days) and 8.3 days (range, 4-15 days), respectively. Thirty-five of the patients (48 ureters) were followed up by ultrasonography for 1-67 months (mean, 19.3 months). Ultrasound scans revealed improvement in the degree of dilatation of 32 ureters. In 1 patient, the ultrasound scan showed deterioration of ureteral dilatation. This patient developed stenosis at the neoureteral opening and underwent reoperation 6 months later. Fourteen patients were followed up by micturating cystourethrogram (MCU).Of these, 3 cases (4 ureters) exhibited reflux (2 unilateral cases of grade 1 reflux and grade 3 reflux, respectively, and 1 bilateral case of bilateral grade 1 reflux).

Pneumovesical ureteral reimplantation for vesicoureteral junction obstruction is feasible and effective. In this series, ultrasound scans showed improvement in most ureteral dilatation cases on follow-up.