A single center study of the efficacy of transvesicoscopic uretero-vesical reimplantation: with or without ureteral tailoring in children with congenital megaureter.

OBJECTIVE: To investigate the efficacy of ureteral tailoring with or without ureteral bladder reimplantation in the treatment of primary megaureter in children by transvesicoscopic ureteral reimplantation.

METHODS: The clinical data of 21 children with primary megaureter in children treated with pneumo-bladder uretero-vesical reimplantation in Anhui Children's Hospital from January 2019 to August 2022 were retrospectively analyzed. Two groups were divided according to whether intraoperative ureteral tailored was performed: 9 cases in the trimmed group and 12 cases in the no- trimmed group; 16 males and 5 females; age (4.7±2.12) years, 17 obstructive MGU, 2 reflux MGU, 2 obstructive with reflux MGU, 16 cases on the left side (including 1 case of Y-shaped ureter in the left duplicated kidney) and 5 cases on the right side; all children underwent transvesicoscopic ureteral reimplantation (Cohen procedure) was performed in all children. To compare the changes in operation time, duration of retained catheterization, hematuria time, renal pelvis and ureteral dilatation and tortuosity in the two groups after double J-tube removal 3 months.

RESULTS: All children were successfully treated under pneumatic-bladder ureteral reimplantation, the operative time (P=0.02,P<0.05), postoperative hematuria time (P=0.00,P<0.05) and retained urinary catheter time (P=0.00,P<0.05) were shorter in the no-trimmed group; the mean postoperative follow-up time was 27.6 (3-22) months. The postoperative anteroposterior diameter of the affected renal pelvis was (0.31±0.39) cm and (0.27±0.29) cm, respectively, and the postoperative maximum ureteral diameter was (0.33±0.31) cm and (0.27±0.36) cm, respectively, in both groups, which were significantly reduced compared with the preoperative ones. The children recovered well and with no postoperative complications.

CONCLUSION: Whether intraoperative ureteral clipping was performed or not had no significant effect on the outcome of pneumoperitoneal laparoscopic ureteric bladder replantation for primary megaureter in children, and both groups improved with satisfactory surgical results, but the non-clipped group had shorter operative time, simpler operation and less trauma.