V3-11: INITIAL EXPERIENCE OF TRANSVESICOSCOPIC INTRAVESICAL DETRUSORRHAPHY WITH URETERAL PLICATION IN PRIMARY MEGAURETER
VideoIntroductions and Objectives
Surgical options for megaureter include Cohen¡¯s transtrigonal technique, Paquin and Politano-Leadbetter reimplantation with ureteral plication. We report our experience of transvesicoscopic intravesical detrusorrhaphy with ureteral plication in patients with non-refluxing megaureter.
We performed transvesicoscopic intravesical detrusorrhaphy with ureteral plication using 3mm pediatric laparoscopic instruments in total 4 patients (2 adults and 2 children) diagnosed as unilateral non-refluxing megaureter. We inserted 6Fr catheter in megaureter and plicated by Vicryl 5-0. We sutured incised detrusor layer by Vicryl 3-0. Finally, we inserted 5Fr catheter or 5Fr stent into reimplanted megaureter.
The ages of 4 patients at the time of surgery were ranged between 3.2 and 24.1 years. Preoperative ultrasound showed grade 4hydronephrosis in all and measured maximal ureteral diameter ranged from 16.0 to 37.7mm. Operation time was 178 to 230 minutes and no intra or postoperative complication occurred. Ultrasound performed at 3 months postoperation revealed decreased hydronpehrosis to grade 2 in all and ureteral diameter was also reduced to 8 to 16mm.
Our initial experience indicates that transvesicoscopic intravesical detrusorrhaphy with ureteral plication is a feasible surgical technique in patients with megaureter. The benefits of this technique are reduced surgical morbidity, preservation of normal ureteral course and excellent cosmesis. Therefore, transvesicoscopic intravesical detrusorrhaphy with plication can be an attractive alternative treatment option for urologists who are skilled in transvesicoscopic surgery.