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[The Cohen cross-trigonal technic for vesicoureteral reflux with contracted bladder in children]
Insights
The Cohen cross-trigonal technique effectively treated vesicoureteral reflux and recurrent urinary infections in a child with a small bladder. This surgical method demonstrated excellent outcomes, preventing infections post-operation.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs) pose significant challenges in pediatric urology.
- A contracted bladder can complicate surgical management of VUR.
Observation:
- An 8-year-old girl presented with a history of VUR and recurrent UTIs since 30 months of age.
- Voiding cystourethrography revealed grade III VUR and a bladder capacity of 75 ml.
- Cystoscopy showed normal ureteral orifice position with a golf-hole appearance.
Findings:
- Successful ureteral reimplantation was performed using the Cohen cross-trigonal advancement technique without ureteral stents.
- Postoperative evaluations, including IVP and renograms, confirmed normal kidney function and no urinary retention.
- Voiding cystourethrography post-surgery showed resolution of VUR, and the patient remained infection-free for 15 months.
Implications:
- The Cohen cross-trigonal technique offers a safe, simple, and applicable surgical option for VUR, particularly in cases involving a contracted bladder.
- This approach effectively resolves VUR and associated recurrent UTIs, improving patient quality of life.
- The technique's success highlights its potential as a preferred method over other anti-reflux operations in specific pediatric patient populations.
Abstract:
A 8-year-old girl was referred with both vesicoureteral reflux and repeated urinary infection since she was 30 months old. At 5 years old, she had had cystoscopy. Her excretory urogram (IVP) was almost normal; her voiding cystogram showed both vesicoureteral reflux of grade III and a maximum bladder capacity of 75 ml. At cystoscopy the ureteral orifices were in normal position of the trigone and the orifices were dilated like a golf-hole. Both ureters were reimplanted without ureter stents by the Cohen cross-trigonal advancement technique. Her IVP and a renograms postoperatively have shown normal kidney function and no urinary retention in either kidney. Her voiding cystograms have shown no vesicoureteral reflux. For 15 months after operation she has had no urinary infection. The Cohen cross-trigonal technique is a simple, safe and more applicable method than other anti-vesicoureteral reflux operations in cases of vesicoureteral reflux with contracted bladder.