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A modified extravesical technique for megaureter repair
G A McLorie1, V R Jayanthi, T J Kinahan
1Department of Urology, Hospital for Sick Children, Toronto, Canada.
Insights
Extravesical detrusorraphy is an effective surgical technique for pediatric megaureter repair, successfully treating both obstruction and reflux with minimal complications. This method offers an alternative to traditional transvesical repairs for dilated ureters.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Ureteral Reconstruction
Background:
- Megaureter, characterized by ureteral diameter exceeding 1.0 cm, affects children and can cause obstruction or reflux.
- Surgical intervention is often necessary for managing symptomatic megaureters in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of the extravesical detrusorraphy technique for repairing pediatric megaureters.
- To compare the outcomes of extravesical megaureter repair with traditional transvesical approaches.
Main Methods:
- A cohort of 23 children (17 boys, 6 girls) with 26 megaureters underwent extravesical repair over 25 months.
- Megaureters were defined by pre-operative imaging showing ureteral diameter >1.0 cm; 14 were obstructing and 12 refluxing.
- Ureteral tapering was performed in 3 refluxing and 5 obstructing megaureters.
Main Results:
- Successful repair was achieved in 21 out of 23 patients (91.3%) using the extravesical approach.
- Complications associated with the extravesical detrusorraphy were minimal.
- The technique demonstrated effectiveness in addressing both obstructive and refluxing megaureters.
Conclusions:
- Extravesical detrusorraphy is a viable and effective surgical option for pediatric megaureter repair.
- This approach provides comparable efficacy to transvesical repairs for correcting obstruction or reflux in dilated ureters.
- The extravesical method offers a safe and successful alternative for managing complex ureteral anomalies in children.
Objective:
To report on the use of extravesical detrusorraphy for megaureter repair.
Patients And Methods:
Twenty-three children underwent an extravesical megaureter repair over a 25 month period. There were 17 boys and 6 girls with an average age of 4.4 years. Three children had bilateral megaureters for a total of 26 repairs. Ureters were defined as megaureters if the ureteric diameter exceeded 1.0 cm on pre-operative imaging. There were 14 obstructing and 12 refluxing ureters. Three of the refluxing ureters were tapered while five of the obstructing megaureters were tapered.
Results:
Twenty-one of the 23 patients were successfully repaired using this method. Complications were minimal.
Conclusion:
The extravesical approach can be used to correct reflux or obstruction in dilated ureters with efficacy equivalent to transvesical repairs.