Operative Treatment of Megaureter

Bischoff, Peter

doi:10.1016/s0022-5347(17)65320-5

Cited by 33 publications

(8 citation statements)

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“…At the next stage, we performed mucosal flaps as a barrier upon the refluxing ureter. It is not an ostioplasty technique as mentioned by Bischoff [6] and Witherington [7] ( fig. 6 ).…”

Section: Discussionmentioning

confidence: 99%

A New Antireflux Technique: Mucosal Flap Barrier

Dayanç¹,

Tahmaz²,

Bedir³

et al. 2007

Urol Int

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Introduction: In this study, our aim was to evaluate the effectiveness of the mucosal flap barrier (MFB) upon the incompetent ureteral orifice of an experimentally produced rabbit reflux model. The rabbit reflux model was done in the first stage of the study. This method is a new and original procedure which is different from Bischoff’s and Witherington’s osteoplasty techniques. Materials and Methods: We performed the mucosal flap procedure in eight 2–2.5 kg male New Zealand rabbits with experimentally produced refluxing ureters. The first stage of our study was to create refluxing ureters. Due to the upward and inward ‘J’ fishhook course of the intravesical ureter of rabbits, we performed two deep 12- and 4-o’clock incisions by suturing the edges of the intravesical ureter apart with catgut sutures. Additionally, to stop the tilting action of the trigonum during micturition, we performed two parallel incisions between the ureteral meatus. These parallel incisions were the authors’ modifications for the rabbit reflux model and which gives long-lasting reflux for the rabbit. We checked the reflux at the end of the 3rd month and performed our new MFB antireflux procedure. This mucosal flap made a cover on the incompetent ureteral orifice. This technique is completely different from the osteoplasty techniques described by Bischoff and Witherington. Results: Four months after the MFB application, we performed intravenous urography, cystometry and cinefluorography. There was no obstruction or reflux. Two rabbits were sacrificed at the 4th month. Both flaps were fully intact without any fixation at the medial side causing obstruction. At present, 3 rabbits are still alive. We did cinefluorography and cystometry at the 15th month and there was no obstruction or reflux. We are trying to keep them alive till the end of their natural lifespan. Conclusions: During the formation of the rabbit reflux model, we observed that spontaneous reflux even at high intravesical pressures did not have high percentages as previously mentioned in the literature. But it is possible and enough to produce an experimental reflux model by using meatotomy and interureteric incisions. Moreover, in rabbits with vesicoureteral regurgitation produced by ureteral meatotomy and interureteral incisions, reflux can be eliminated the MFB procedure. This method is an easy procedure for small bladders or dilated ureters after any kind of open reimplantation applications and it could be used by pneumovesical applications in the future.

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“…At the next stage, we performed mucosal flaps as a barrier upon the refluxing ureter. It is not an ostioplasty technique as mentioned by Bischoff [6] and Witherington [7] ( fig. 6 ).…”

Section: Discussionmentioning

confidence: 99%

A New Antireflux Technique: Mucosal Flap Barrier

Dayanç¹,

Tahmaz²,

Bedir³

et al. 2007

Urol Int

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“…Hirschborn [19] described wrapping the ureter with a sleeve of ileum from which mucosa had been removed; our limited observation of this method did not demonstrate its success. Bischoff [2] radically shortened and straightened dilated megaureters extravesically. In those with reflux, a local plasty to the ureteral orifice was performed to create a tunnel from bladder mucosa to prevent reflux.…”

Section: Management Of Megauretermentioning

confidence: 94%

Megaureter

Hendren¹

1981

The Ureter

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“…the Gregoir method). (c) Lengthening of the intravesical part of the ureter, of which the best known technique is the Bischoff operation [4].…”

mentioning

confidence: 99%

Surgical treatment of vesicoureteral reflux in children

Szendroi¹,

Lancos²,

Töth³

1969

Urology and Nephrology

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There is no universally applicable method for the treatment of vesicoureteral reflux. In choosing the conservative measures or surgical technique, aetiology, the presence of other congenital or acquired urogenital changes, and the consequences of vesicoureteral reflux should be taken into consideration.During the past 10 years anti-reflux operations have been performed in 66 children; neoimplantation in 24, Boari's plastic operation in 33 and Gregoir's operations in 5 cases. The results of operation have been more favourable in bladder neck sclerosis, congenital anomalies of the orifice and megaureter than in the cases of inflammation. As far as the different operations are concerned, Boari's plastic operation has proved to produce the best results.The wide variety of operations employed in the management of vesicoureteral reflux indicates that there is no single method that would be universally acceptable for the surgical treatment of this disease of different origin. On the other hand, the poor results show that the problem merits further investigations.There is no uniform opinion as to the methods of choice in conservative or surgical treatment [15]. In our view the folIowing factors should be taken into consideration in this respect: (1) aetiology; (2) the presence of other congenital or acquired urogenital changes and, (3) the severity of the sequelae of vesicoureteral reflux (infection, impairment of renal function, etc.).(1) As known, vesicoureteral reflux caused by infection alone may regress spontaneously [8]. In cases of primary or secondary alterations restricted to the area of the ureteral orifice with normal upper system and bladder emptying all the operations may be taken into consideration which have been classified by Bettex [2,3] in the following way. (a) Various forms of ureteroneocystostomy; to this group belong the most widely used Boeming and Vest technique for papilla formation as well as the various types of submucosal canalization like the Politano--Leadbetter [12,13] All these methods are, in our opinion, unsuitable when the ureteral wall is rigid, the ureter is dilated or megaureter is present [14], In such cases an active Urology and Nephrology 1, 1969

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Operative Treatment of Megaureter

Cited by 33 publications

References 0 publications

A New Antireflux Technique: Mucosal Flap Barrier

A New Antireflux Technique: Mucosal Flap Barrier

Megaureter

Surgical treatment of vesicoureteral reflux in children

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