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  • Title: Laparoscopic pneumovesical ureteral tapering and reimplantation for megaureter.
    Author: Bi Y, Sun Y.
    Journal: J Pediatr Surg; 2012 Dec; 47(12):2285-8. PubMed ID: 23217890.
    Abstract:
    OBJECTIVE: To evaluate the efficacy of laparoscopic pneumovesical ureter reimplantation for congenital malformation involving the vesicoureteral junction in children. METHODS: From January 2005 to October 2010, 45 cases (comprising 61 ureters) were diagnosed as megaureter caused by vesicoureteral junction obstruction. A pneumovesical laparoscopic Cohen procedure was performed in all cases. Twelve of the ureters underwent excisional ureteral tapering. Ureteral diameters were obtained using ultrasonography and were divided into 4 groups according to the degree of dilatation. RESULTS: The procedure was completed in all but 2 patients, who were converted to open surgery. The mean operation time was 3.5h (range, 2-8h) for unilateral ureter cases, 3.7h (range, 3.5-4.5h) for duplicated ureter cases, and 5.4h (range, 3.5-9h) for bilateral cases. The mean duration of urethral catheter placement and hospital stay was 6.7 days (range, 3-14 days) and 8.3 days (range, 4-15 days), respectively. Thirty-five of the patients (48 ureters) were followed up by ultrasonography for 1-67 months (mean, 19.3 months). Ultrasound scans revealed improvement in the degree of dilatation of 32 ureters. In 1 patient, the ultrasound scan showed deterioration of ureteral dilatation. This patient developed stenosis at the neoureteral opening and underwent reoperation 6 months later. Fourteen patients were followed up by micturating cystourethrogram (MCU).Of these, 3 cases (4 ureters) exhibited reflux (2 unilateral cases of grade 1 reflux and grade 3 reflux, respectively, and 1 bilateral case of bilateral grade 1 reflux). CONCLUSIONS: Pneumovesical ureteral reimplantation for vesicoureteral junction obstruction is feasible and effective. In this series, ultrasound scans showed improvement in most ureteral dilatation cases on follow-up.
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