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Published on: December 11, 2017
'Mini' extravesical reimplant with 'mini' tapering for infants younger than 6 months
1University of Nebraska Medical Center/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA.
Introduction:
Some infants with obstructed megaureters or ectopic ureters requiring surgery undergo a cutaneous ureterostomy followed by definitive repair after 12 months of age. Since 2013, a 'mini' extravesical reimplant with or without 'mini' tapering (MER) was performed instead of cutaneous ureterostomy in such infants.
Objective:
To describe the technique and outcomes for MER.
Study Design:
This is a retrospective review of infants younger than 6 months who underwent MER. MER consists of a 2- to 3-cm extravesical tunnel, regardless of the ureter diameter. 'Mini' tapering consisted of an adventitial sparing technique involving only the distal 2-3 cm of the ureter. Details of the technique are included in the video. The main outcomes were postoperative symptomatic urinary tract infections (UTI's) and reoperations. Voiding function was assessed at the last contact with the family.
Results:
Nine consecutive infants underwent MER from July 2013 to March 2018. Four patients had ectopic ureters and five had primary obstructed megaureters. The median ureteral diameter was 1.5 cm. Indications for surgery were as per the British Association of Pediatric Urologists guidelines on megaureters. All patients had 3-month postoperative renal ultrasound, and seven of the nine patients had postoperative voiding cystourethrogram (VCUG). One patient with a normal postoperative VCUG and MAG 3, as well as resolved hydroureteronephrosis had a few postoperative febrile UTIs but no more for >1 year at the last follow-up. At a median time from surgery of 44 months, there have been no reoperations (except cystoscopy with stent removal). With regard to voiding function, six patients were successfully potty trained, one has bowel and bladder incontinence at the age of 4 years - with stable renal ulstraound -, and two are younger than 2 years.
Discussion:
MER has been the only surgery needed for the cohort of nine infants younger than 6 months with distal ureteral obstruction at a median time from surgery of 44 months. Voiding function does not appear to be affected by the operation.
Conclusions:
For babies younger than 6 months of age in need of surgery for obstructed distal ureter, MER appears to be a feasible and effective option, associated with reduced morbidity and reoperation rate compared to the alternatives.
