Endoscopic Correction of Vesicoureteric Reflux in Failed Reimplanted Ureters

Kumar, Rajendra; Puri, Prem

doi:10.1159/000019519

Cited by 18 publications

(4 citation statements)

References 20 publications

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“…In our case, the transplanted ureter showed functional characteristics of a lead pipe ureter, similar to that showed in the colon, with slow drainage through it. A diagnosis of lead pipe ureter had been suggested in the past, as a possible cause of persistent vesicoureteral reflux after ureteral reimplantation surgery, with a non compressible ureter induced by chronic inflammatory or ischemic changes [11]. The transplanted ureter in our case which was stiff and unable to lead the urine output effectively, though no vesicoureteral reflux was demonstrated, showed slight resemblance.…”

Section: Discussionmentioning

confidence: 56%

„Lead Pipe” Ureter after Renal Transplantation

2012

Med. Con.

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Objective: To describe a case of "lead pipe" transplanted ureter.Case: A 16-year-old boy presented with a progressive increase in serum creatinine level and hydronephrosis 8 months after renal transplantation. An indwelling urethral catheter had not improved renal function. Following insertion of a nephrostomy tube, the creatinine level normalized. Antegrade pyelography demonstrated slow passage of contrast material through the ureter with no stricture.Result: Treatment consisted of ureteropyelostomy of the native ureter to the transplanted kidney. Serum creatinine level subsequently stabilized, and the hydronephrosis decreased.Conclusion: This is the first reported case of a "lead pipe" transplanted ureter in a child, probably caused by ischemia. Clinicians should be alerted to this possibility in pediatric renal transplant recipients with rising serum creatinine and progressive hydronephrosis, even in the absence of imaging findings of obvious obstruction.

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Section: Discussionmentioning

confidence: 56%

„Lead Pipe” Ureter after Renal Transplantation

2012

Med. Con.

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“…Following one injection, they noted a success rate of 88%. This is supported by earlier work with polytetrafluoroethylene, which described a success rate of 68% with one injection and 95% after three injections [22]. Although many instances of persistent reflux following open repair may resolve with observation, the addition of an endoscopic solution provides a further option.…”

Section: The Use Of Deflux In Failed Open Surgerymentioning

confidence: 54%

The extended use of deflux (dextranomer/hyaluronic acid) in pediatric urology

Dean

Doumanian²

2006

Curr Urol Rep

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The use of injectable bulking agents into the submucosal layer of the pediatric urinary tract continues to grow. Treatment strategies for vesicoureteral reflux and urinary incontinence have changed with the introduction of dextranomer/hyaluronic acid as a minimally invasive option. Socially and medically debilitating conditions requiring major surgical reconstruction and hospitalization in the past have now been replaced by outpatient endoscopic procedures. As experience has been gained, broader uses of this agent have been applied to more complex etiologies of reflux and incontinence.

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“…It is reasonable to attempt bulking agent injection as first-line treatment, as their reported success rates range between 67 and 95%. [8][9][10] Other options include leaving the ureteral orifice in its orthotopic position and elongating the tunnel. This can be achieved laparoscopically, 11 with an open approach, or by performing a dismembered approach, which is usually performed in an open manner.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of reflux, it is hypothesized that insufficient length of the submucosal tunnel is the leading cause for ureteral reflux after open repair; therefore, the surgical options are similar to the initial approach to primary reflux. It is reasonable to attempt bulking agent injection as first-line treatment, as their reported success rates range between 67-95% 8,9,10 . Other options include leaving the ureteral orifice in its orthotopic position and elongating the tunnel.…”

Section: Irrespective Of the Initial Indication For Open Surgery (Ref...mentioning

confidence: 99%

Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length

et al. 2022

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Background Failure after open ureteral reimplantation has been reported to occur in 2-7% of cases. While a second open reconstructive surgery is appropriate in most cases, there are data suggesting similar outcomes utilizing the laparoscopic approach. The objective of this study is to describe a modification and report our experience with laparoscopic ureteral reimplantation after failed open reimplantation reinforced with a psoas hitch. Methods A retrospective review of pediatric patients who underwent laparoscopic ureteral reimplantation after failed open surgery between September 2012 and April 2018 at three different academic centers was performed. Patient demographics, surgical indications, complications and outcomes were reviewed. Either ipsilateral ureteral reimplantation with a combined intravesical and extravesical approach or a cross-trigonal extravesical approach was utilized, depending on the length of the ureter. In all cases a psoas hitch was performed to gain a longer submucosal tunnel and relieve tension, thus facilitating an efficient anti-reflux mechanism. Results Seventeen patients underwent a laparoscopic ureteral reimplantation after failed open surgery. Median age at second surgery was 106 months (IQR 53-122.5). Ipsilateral ureteral reimplantation with a combined intravesical and extravesical approach was performed in 11 cases and cross-trigonal extravesical approach in 6. Median ureteral diameter before the re-do surgery was 16 mm (IQR 14.5-18.5) and after surgery 6 mm (IQR 3.5-8.5), (p<0.001). Postoperative mercaptoacetyltriglycine (MAG3) renal scan showed a non-obstructive pattern and stable renal function in all cases. Conclusion Laparoscopic ureteral reimplantation with incorporation of a psoas hitch after failed open reimplantation is safe and effective.

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Endoscopic Correction of Vesicoureteric Reflux in Failed Reimplanted Ureters

Cited by 18 publications

References 20 publications

„Lead Pipe” Ureter after Renal Transplantation

„Lead Pipe” Ureter after Renal Transplantation

The extended use of deflux (dextranomer/hyaluronic acid) in pediatric urology

Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length

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