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Utilizing an Umbilical Ligament for Complex Ureteroneocystostomy
Futoshi Matsui1, Kenji Shimada1, Fumi Matsumoto1
1Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Insights
This study introduces a novel technique using the umbilical ligament to fix the bladder during ureteroneocystostomy in children, reducing tension and improving outcomes. The method demonstrated high success rates with no complications or obstructions in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Complex ureteroneocystostomy in children often involves tension at the ureter-bladder anastomosis.
- Existing techniques may struggle to adequately address this tension, leading to potential complications.
Purpose of the Study:
- To describe and evaluate a novel surgical technique for complex ureteroneocystostomy in pediatric patients.
- To utilize the ipsilateral umbilical ligament to alleviate tension during ureteroneocystostomy.
Main Methods:
- A cohort of 18 pediatric patients underwent ureteroneocystostomy using the ipsilateral umbilical ligament for bladder fixation.
- The technique involved creating a new hiatus, a trans-trigonal submucosal tunnel, and suturing the umbilical ligament to the bladder muscle.
- Follow-up averaged 62.6 months for unilateral and bilateral procedures.
Main Results:
- Vesicoureteral reflux was absent in 92.3% of patients post-procedure.
- No signs of urinary tract obstruction were observed in any patient.
- The procedure was associated with no reported complications.
Conclusions:
- Fixation of the bladder with the umbilical ligament is an effective strategy for managing tension in ureteroneocystostomy.
- This innovative approach appears suitable for a wide range of complex pediatric ureteroneocystostomy cases.
Introduction:
To overcome the tension of anastomosis between ureter and bladder for complex ureteroneocystostomy in children, we describe a novel technique utilizing an ipsilateral umbilical ligament (occluded umbilical artery) to fix the bladder.
Technical Considerations:
From July 1991 to December 2013, 18 patients (13 girls, 5 boys) underwent our technique for complex ureteroneocystostomy. Median age at surgery was 61 months. The main indications for surgery were ectopic ureter in 9 patients, primary obstructive megaureter in 3, and persistent vesicoureteral reflux after surgery in 2. The ipsilateral umbilical ligament was ligated. A new hiatus was created craniolateral to the original hiatus. The submucosal tunnel was created trans-trigonally. The umbilical ligament was sutured to the whole bladder muscle at the hiatus. Ureteroneocystostomy was then performed. Mean duration of postoperative follow-up was 62.6 months. Seventeen patients underwent unilateral ureteroneocystostomy with our technique. One patient underwent bilateral ureteroneocystostomy with our technique on one side. Vesicoureteral reflux was not shown in 92.3% of patients and no signs of obstruction developed in any patients. No complications were encountered with our procedure.
Conclusions:
Utilizing an umbilical ligament for ureteroneocystostomy to fix the bladder is an excellent option when the distal ureter creates tension in uretero-bladder anastomosis. This method seems to be applicable in many cases of complex ureteroneocystostomy in children.
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