A modified technique for ureteral reimplantation: Intravesical detrusorrhaphy

• Published in: Journal of pediatric surgery 2013-08, Vol.48 (8), p.1813-1818
• Main Authors: Kim, Kwang Hyun, Lee, Yong Seung, Im, Young Jae, Lee, Cho Nyeong, Han, Sang Won
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical; Child, Preschool; Female; Follow-Up Studies; Humans; Hydronephrosis - diagnostic imaging; Hydronephrosis - surgery; Infant; Male; Mucous Membrane - surgery; Pediatrics; Postoperative Complications - prevention & control; Replantation; Replantation - methods; Retrospective Studies; Surgery; Treatment Outcome; Ureter; Ureter - abnormalities; Ureter - diagnostic imaging; Ureter - surgery; Ureteral Obstruction - etiology; Ureteral Obstruction - surgery; Urinary bladder; Urinary Bladder - diagnostic imaging; Urinary Bladder - surgery; Urography; Vesico-ureteral reflux; Vesico-Ureteral Reflux - surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.05.017

Abstract Purpose To describe the surgical procedure of intravesical detrusorrhaphy, a modified technique of ureteral reimplantation, and report our initial experience. Methods From October 2007 to March 2012, 55 children with vesicoureteral reflux (VUR) and 13 children with obstructive megaureter (OM) underwent intravesical detrusorrhaphy. All surgical procedures were performed via an open intravesical approach. The ureter was mobilized, and the bladder mucosa was separated from the detrusor in a cephalad direction. The separated detrusor was incised vertically and repaired underneath the mobilized ureter to create the submucosal tunnel. The ureteral orifice was anastomosed to its orthotopic position. Results Of 31 patients treated with bilateral intravesical detrusorrhaphy, no patient had postoperative urinary retention. Follow-up voiding cystourethrography was performed in 45 patients with 72 reimplanted ureters. VUR was resolved in 41 patients (91.1%) with 68 ureters (94.4%). Among 13 patients with 14 ureters treated for OM, hydroureteronephorosis improved in 11 patients (84.6%) with 12 ureters (85.7%). Conclusions Intravesical detrusorrhaphy is modified technique of ureteral reimplantation, which recreates the neo-ureteric orifice in the orthotopic position and does not produce postoperative urinary retention in bilateral cases. Intravesical detrusorrhaphy is safe and effective in treating patients with VUR or OM.