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Extravesical detrusorrhaphy for refluxing ureters associated with paraureteral diverticula
V R Jayanthi1, G A McLorie, A E Khoury
1Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
The extravesical approach effectively repairs refluxing ureters in children with paraureteral diverticula, showing high success rates and minimal complications. This safe and simple method offers a promising solution for managing this condition.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Vesicoureteral Reflux Management
Background:
- Paraureteral diverticula are congenital anomalies that can lead to vesicoureteral reflux (VUR).
- Surgical intervention is often necessary to correct VUR associated with these diverticula.
Purpose of the Study:
- To evaluate the efficacy of an extravesical surgical approach for treating refluxing ureters in children with paraureteral diverticula.
- To assess the safety and outcomes of this minimally invasive technique.
Main Methods:
- A retrospective review of 23 children who underwent extravesical repair of Hutch diverticula with refluxing ureters over 39 months.
- Procedures included nondismembered and dismembered techniques, addressing 25 ureters in total.
Main Results:
- Successful repair was achieved in 96% of patients (22 out of 23).
- Three patients experienced transient postoperative reflux that resolved spontaneously.
- One patient had persistent reflux after bilateral dismembered procedures; no ureteral obstruction occurred.
Conclusions:
- The extravesical approach is a safe, simple, and effective treatment for refluxing ureters associated with paraureteral diverticula.
- This technique offers the significant advantage of minimal postoperative morbidity.
Objectives:
To demonstrate the effectiveness of an extravesical approach to refluxing ureters associated with paraureteral diverticula.
Methods:
Over a 39-month period, 23 children underwent repair of Hutch diverticula with refluxing ureters using an extravesical approach. Seventeen had unilateral reflux with an ipsilateral diverticulum, 4 had bilateral reflux with a unilateral diverticulum, and 2 had bilateral reflux with bilateral diverticula. Overall, 25 ureters with associated diverticula were repaired.
Results:
Twenty ureters were repaired with a nondismembered technique and 5 with a dismembered technique. Twenty-two of the 23 patients (96%) were successfully repaired with this approach. Three patients had transient reflux postoperatively, which resolved spontaneously within 6 months. One patient who underwent bilateral dismembered procedures for bilateral diverticula has persistent unilateral grade II reflux postoperatively. No patient developed ureteral obstruction.
Conclusions:
The major advantage of this technique is seen in the minimal postoperative morbidity. The extravesical approach is a safe, simple, and effective method for the management of a refluxing ureter with an associated diverticulum.