gms | German Medical Science

Einleitung: Pneumovesicoscopic ureteric reimplantation (Cohen’s type) proved to be a safe and beneficial approach to children with significant vesicoureteral reflux (VUR). The present study investigates the feasibility of this method to correct more complex anatomical cases of VUR like paraureteral (Hutch) diverticulum and megaureter.

Material und Methoden: 6 patients (age 11 months to 8.5 years) had recurrent UTI due to VUR (grade 3-5) associated with Hutch diverticulum (unilateral VUR in 4, bilateral VUR in 2, 1 additional megaureter). Transurethral cystoscopic guidance served for placement of the camera port (5 mm). The bladder was evacuated to install the pneumovesicum (CO2 pressure of 10-12 mmHg). After insertion of two working ports (5mm), the diverticulum could be mobilized and resected. The ureter was followed for 2.5 to 3cm into the extravesical space (the megaureter was then tapered inside the bladder (interrupted 5-0 vicryl). A submucosal tunnel was created (Cohen’s type) and the ureter was drawn through the tunnel and the ureterocystoneostomy was completed (interrupted 5-0 Biosyn). For bilateral VUR, one child received subureteral Deflux injection simultaneously, the other bilateral reimplantation.

Ergebnisse: All procedures were completed successfully. Mean operating time was 173 min. (range 140-200 min.). Patients were discharged 1.7 days postoperatively without a stent (range 1-3 days). Follow-up after 3 months showed no evidence of significant VUR, no diverticulum recurrence or ureteral obstruction.

Schlussfolgerung: Children with Hutch diverticulum and associated VUR can be corrected effectively by pneumovesicoscopic ureteral reimplantation. The long-term outcome will need further evaluation.