Cohen ureteral reimplantation: sonographic appearance

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Surgical Outcomes

Background:

• The Cohen ureteroneocystostomy is a surgical procedure to correct vesicoureteral reflux.
• Accurate post-operative imaging is crucial for assessing surgical success and identifying potential complications.

Purpose of the Study:

• To describe the sonographic appearance of the reimplanted ureter after Cohen ureteroneocystostomy.
• To introduce the "tunnel sign" as a recognizable sonographic finding in this patient population.

Main Methods:

• Retrospective review of sonographic records from 27 children who underwent Cohen ureteroneocystostomy.
• Analysis of sonographic findings, specifically focusing on structures near the trigone and bladder wall.

Main Results:

• An echogenic, non-shadowing structure was identified in 13 children (48%) at or above the trigone.
• This structure was consistently located within the bladder wall, covered by mucosa, and fixed in position.
• This sonographic pattern was termed the "tunnel sign" and represents the submucosal course of the reimplanted ureter.

Conclusions:

• The "tunnel sign" is a characteristic sonographic finding following Cohen ureteroneocystostomy.
• Sonographers should be aware of this sign to accurately interpret bladder imaging in pediatric patients post-surgery.
• Recognition of the "tunnel sign" can improve the evaluation of children who have had bladder surgical procedures.