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Experience of the Cohen method for ureteral reimplantation in complicated cases
Insights
Ureteral reimplantation surgery using the Cohen technique proved highly effective, with a 90% success rate in infants and children, even those with complex conditions like neurogenic bladder.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Urology
Background:
- Vesicoureteral reflux (VUR) is common in children.
- Ureteral reimplantation is a standard surgical treatment for VUR.
- The Cohen technique is a widely used method for ureteral reimplantation.
Purpose of the Study:
- To evaluate the efficacy of the Cohen ureteral reimplantation technique.
- To assess outcomes in a cohort of infants and children, including those with complicating factors.
- To determine if minor deviations from the standard technique impact success rates.
Main Methods:
- Retrospective analysis of 37 infants and children (41 ureters) undergoing ureteral reimplantation.
- Application of the Cohen technique, with documented variations in suturing material, catheter splinting, and submucosal tunnel length.
- Assessment of surgical outcomes and complication rates.
Main Results:
- Successful outcomes were achieved in 90% of the treated ureters.
- Complicating factors such as young age, neurogenic bladder, ureteral duplication, and reoperative surgery were present in a majority of cases.
- Minor technical deviations did not negatively affect the overall success rate.
Conclusions:
- The Cohen ureteral reimplantation technique is a safe and effective treatment for pediatric VUR.
- The procedure demonstrates high success rates even in complex cases with complicating factors.
- The technique is adaptable, with minor modifications not compromising outcomes, making it suitable for challenging pediatric urological cases.
Abstract:
Thirty-seven infants and children (41 ureters), a majority with complicating factors (low age, neurogenic bladder, duplication, reoperative surgery), were treated with ureteral reimplantation according to Cohen. The results were good in 90% of the cases. Minor deviations from the original technique, i. e. Dexon instead of chromic catgut as suturing material, catheter splinting of ureter in only 40% and short length of submucosal tunnel in some cases, did not seem to have a negative influence on the results. The method, which is easy and safe to perform, is recommended, particularly in complicated cases.