Laparoscopic Reconstruction for Obstructive Megaureter: Single Institution Experience with Short- and Intermediate-Term Outcomes

Abstract

Purpose:

To narrate our experience with laparoscopic reconstruction of obstructive megaureter (MGU) and assess the intermediate-term outcome achieved.

Patients and Methods:

Patients were evaluated in detail including presenting complaints, biochemical profile, and imaging (ultrasonography [USG], diuretic renography [DR], magnetic resonance urography [MRU], and voiding cystourethrography [VCUG]). All patients with a diagnosis of obstructive MGU and salvageable renal unit were offered laparoscopic reconstruction. The standard laparoscopic exercise included ureteral adhesiolysis until the pathologic segment, dismemberment, straightening of the lower ureter, excisional tapering, and a nonrefluxing ureteroneocystostomy. Operative and postoperative parameters were recorded. Patients were evaluated postprocedure on a 3-month schedule. Follow-up imaging included USG and VCUG at 6 months and 1 year postprocedure and then at yearly intervals. MRU and DR were repeated at 1 year postprocedure.

Results:

Twelve patients (13 units—11 unilateral, and 1 bilateral) underwent laparoscopic tailoring and reimplantation for obstructive MGU. Mean age was 98.6 months. All patients were male. Mean body mass index was 17.69 kg/m². Presenting complaints were flank pain (n=8) and recurrent urinary infection (n=12). All procedures were completed via a laparoscopic approach. Mean operation duration was 183 minutes, and mean blood loss was 75 mL. Mean duration of hospital stay was 2.1 days. No major intraoperative or postoperative happenings were recorded. All patients were asymptomatic at follow-up with stable renal profile. Follow-up MRU revealed a decrease in ureteral and upper tract dilatation with satisfactory drainage in all. Follow-up VCUG demonstrated grade I vesicoureteral reflux in one patient. Eight patients completed 3-year follow-up with a satisfactory outcome.

Conclusion:

Laparoscopic reconstruction of obstructive MGU offers satisfactory immediate- and intermediate-term outcome without undue prolonged morbidity.

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References

Williams

, Hulme-Moir

. Primary obstructive mega-ureter. Br J Urol, 1970; 42:140–149.

Arena

, Baldari

, Proietto

et al. Conservative treatment in primary neonatal megaureter. Eur J Pediatr Surg, 1998; 8:347–351.

Kajbafzadeh

, Payabvash

, Salmasi

et al. Endoureterotomy for treatment of primary obstructive megaureter in children. J Endourol, 2007; 21:743–749.

Tatlisen

, Ekmekçioglu

. Direct nipple ureteroneocystostomy in adults with primary obstructed megaureter. J Urol, 2005; 173:877–880.

Lee

, Akbal

, Kaefer

. Refluxing ureteral reimplant as temporary treatment of obstructive megaureter in neonate and infant. J Urol, 2005; 173:1357–1360.

Khoury

, Bagli

. Reflux and megaureter. Wein

, Kavoussi

, Novick

et al. Campbell-Walsh Urology, 9th. Philadelphia: Saunders Elsevier, 2007; 3467–3480.

Kaouk

, Gill

. Laparoscopic reconstructive urology. J Urol, 2003; 170:1070–1078.

Agarwal

, Singh

, Agarwal

et al. A novel technique of intracorporeal excisional tailoring of megaureter before laparoscopic ureteral reimplantation. Urology, 2010; 75:96–99.

Josephson

, Dhillon

, Ransley

. Post-natal management of antenally detected, bilateral hydronephrosis. Urol Int, 1993; 51:79–84.

10.

Parrott

, Woodard

, Wolpert

. Ureteral tailoring: A comparison of wedge resection with infolding. J Urol, 1990; 144:328–329.

11.

Bakker

, Scholtmeijer

, Klopper

. Comparison of 2 different tapering techniques in megaureters. J Urol, 1988; 140:1237–1239.

12.

Abraham

, Das

, Ramaswami

et al. Laparoscopic Boari flap ureteroneocystostomy in single and double renal units: Our experience. J Endourol and Part B VideourologyFirst publishedJanuary 2011, 10.1089/vid.2011.0067.

13.

Abraham

, Das

, Ramaswami

et al. Laparoscopic simulataneous bilateral ureteric tailoring, intracorporeal suturing, and reimplantation for obstructive megaureter—first case report with points of technique. J Laparoendosc Surg and Part B Videoscopy, April 21, 2011.

14.

Abraham

, Das

, Ramaswami

et al. Laparoscopic extravesical ureteric reimplantation for resolving vesicoureteric reflux in single, bilateral and duplex system-points of technique. J Endourol Part B VideourologyFirst publishedJanuary 2011, 10.1089/vid.2011.0006

15.

Abraham

, Das

, Ramaswami

et al.

Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

Indian J Urol, 2011; 27:465–469.

16.

Abraham

, Das

, Ramaswami

et al. Laparoscopic dismemberment, excisional tailoring, reimplantation with antireflux- megamanagement for megaureter. J Endourol and Part B Videourology, October 2011; 25, 10.1089/vid.2011.0049.

17.

Ansari

, Mandhani

, Khurana

, Kumar

. Laparoscopic ureteral reimplantation with extracorporeal tailoring for megaureter: A simple technical nuance. J Urol, 2006; 176:2640–2642.

18.

Lakshmanan

, Fung

. Laparoscopic extravesicular ureteral reimplantation for vesicoureteral reflux: Recent technical advances. J Endourol, 2000; 14:589–594.

19.

Gill

, Ponsky

, Desai

et al. Laparoscopic cross-trigonal Cohen ureteroneocystostomy: Novel technique. J Urol, 2001; 166:1811–1814.

20.

Chen

, Yuan

, Lin

. Ureteral reimplantation for vesicoureteral reflux: Comparison of minimally invasive extravesical with transvesical and conventional extravesical techniques. Urology, 2004; 63:364–368.

21.

DeFoor

, Minevich

, Reddy

et al. Results of tapered ureteral reimplantation for primary megaureter: Extravesical versus intravesical approach. J Urol, 2004; 172:1640–1643.

22.

Hemal

, Nayyar

, Rao

. Robotic repair of primary symptomatic obstructive megaureter with intracorporeal or extracorporeal ureteric tapering and ureteroneocystostomy. J Endourol, 2009; 23:2041–2046.

23.

Link

, Slobodov

, Campbell

, Kropp

. Radiographic changes following excisional tapering and reimplantation of megaureters in childhood: Long term outcome in 46 renal units. J Urol, 2007; 178:1474–1478.