A Novel Technique of Intracorporeal Excisional Tailoring of Megaureter Before Laparoscopic Ureteral Reimplantation
Received 24 March 2009; accepted 7 July 2009. published online 05 October 2009.
Objectives
To present our initial results of a novel technique of intracorporeal laparoscopic tailoring of megaureter (MGU) and nonrefluxing reimplantation.
Methods
Three young male patients presented with flank pain (3) and recurrent urinary tract infection (2). Investigations revealed refluxing MGU in 2 and obstructing MGU in 1. Laparoscopic tailoring and reimplantation was planned. Ureteral mobilization was carried out using a standard 3-port access. An additional 5 mm port was inserted under vision for “dynamic” traction on ureter using a vessel loop without disconnecting the ureter from hiatus. This maneuver led to a fixed anatomic orientation and a firm platform of ureter greatly facilitating excisional tailoring and resuturing. After this, a ureteral stent was inserted through one of the laparoscopic ports and reimplantation of ureter was carried out in nonrefluxing fashion using extravesical, suprahiatal technique.
Results
No immediate postoperative complications were observed. Stents were removed 6 weeks after surgery. Pain resolved in 2 and greatly improved in 1. None of the patients developed urinary tract infection during follow up. Follow up studies revealed complete resolution of reflux in 1 patient with grade V reflux and residual minimally symptomatic high-pressure (voiding) grade II reflux in another. Patient with obstructive MGU has grade I asymptomatic reflux.
Conclusions
Our technique of intracorporeal laparoscopic excisional tailoring of MGU is feasible and reproducible.
Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Reprint requests: Shrawan K. Singh, Advanced Urology Center, Level II, B Block, Nehru Hospital, PGIMER, Sector 12, Chandigarh 160012, India
ABSTRACT