Ureteric orifice deformation causing secondary reflux

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Vesicoureteric Reflux Management

Background:

• Posterior urethral valves (PUV) are a common congenital anomaly in male infants, often requiring surgical intervention.
• Ureteroneocystostomy, a procedure to reimplant the ureters, is used to treat associated complications like vesicoureteric reflux (VUR).
• The Politano-Leadbetter technique is a standard surgical approach for ureteroneocystostomy.

Observation:

• Two male infants with PUV and dilated ureters underwent Politano-Leadbetter ureteroneocystostomy at 4 and 6 months of age.
• Postoperatively, both patients developed significant vesicoureteric reflux.
• Endoscopic evaluation identified a mucosal bridge between the medial aspects of the ureteric orifices in both cases.

Findings:

• Transurethral endoscopic diathermy was utilized to transect the identified mucosal bridges.
• Following the endoscopic intervention, vesicoureteric reflux resolved permanently in both patients.
• The study suggests that ureteric orifice fixation and deformation secondary to surgery may contribute to postoperative reflux.

Implications:

• Endoscopic management of ureteric orifice mucosal bridges offers a minimally invasive solution for refractory postoperative VUR.
• This approach may prevent the need for further complex reconstructive surgery.
• Routine endoscopic assessment is recommended for children experiencing VUR after ureteroneocystostomy.