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Initial results with the Cohen cross-trigonal ureteroneocystotomy
Insights
The Cohen cross-trigonal ureteroneocystotomy is a safe and effective surgical treatment for pediatric vesicoureteral reflux. This antireflux procedure demonstrated excellent outcomes in a retrospective study of pediatric ureters.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Reflux Management
Background:
- Vesicoureteral reflux (VUR) affects numerous children, necessitating effective management strategies.
- Conservative management and surgical intervention are primary treatment options for pediatric VUR.
- The Cohen cross-trigonal ureteroneocystotomy is a recognized surgical approach for VUR.
Purpose of the Study:
- To evaluate the safety and efficacy of the Cohen cross-trigonal ureteroneocystotomy for pediatric VUR.
- To assess the outcomes of this surgical technique in a cohort of children with refluxing ureters.
Main Methods:
- Retrospective review of 109 children (157 ureters) with VUR treated between 1976 and 1980.
- Surgical group: 52 ureters treated with Cohen cross-trigonal ureteroneocystotomy.
- Conservative group: 105 ureters managed non-operatively.
- Follow-up included excretory urography and voiding cystourethrography.
Main Results:
- The Cohen cross-trigonal ureteroneocystotomy group showed minimal hydronephrosis in only 1 ureter.
- Persistent grade I reflux was observed in 1 ureter post-operatively.
- Conservative management outcomes were not detailed in comparison but implied less favorable results.
Conclusions:
- The Cohen cross-trigonal ureteroneocystotomy is a safe and effective antireflux procedure for pediatric VUR.
- This technique demonstrates a low rate of complications and persistent reflux.
- Initial results support the Cohen technique as a viable surgical option for managing pediatric VUR.
Abstract:
Between January 1976 and December 1980, 109 children with 157 ureters with reflux were seen in consultation. Of these ureters 52 were operated upon using the Cohen cross-trigonal technique, while 105 were followed conservatively. The operative procedure is a complete intravesical ureteral mobilization followed by the creation of a submucosal tunnel across the base of the bladder. Followup studies, including an excretory urogram and voiding cystourethrogram, showed minimal hydronephrosis in 1 ureter and persistent grade I reflux in 1 ureter. Evaluation of these initial results indicates that the Cohen cross-trigonal ureteroneocystotomy is a safe and effective antireflux procedure.