Extravesical diverticuloplasty for repair of a paraureteral diverticulum and the associated refluxing ureter.
OBJECTIVE
Extravesical diverticuloplasty for repairing a paraureteral (Hutch) diverticulum and the related refluxing ureter is presented.


METHODS
Of the 16 children in this study 10 had bilateral paraureteral diverticula with associated bilateral vesicoureteral reflux, 2 had bilateral paraureteral diverticula with a bilateral duplicated ureter, unilateral duplex refluxing ureters and contralateral lower moiety vesicoureteral reflux, and 4 had a unilateral paraureteral diverticulum with an ipsilateral refluxing ureter. The anatomical relationship of the ureteral orifice and diverticulum was identified by cystourethroscopy preoperatively and confirmed during the extravesical operation. The surgical technique differed depending on the size of the diverticulum and the position of the ureteral opening when the bladder was completely distended. The larger prolapsed diverticular mucosa served as a backing for the detrusor muscle, which was closed over the ureter, and the smaller diverticulum was repaired as a dilated ureter. Overall 30 renal units with grades II to IV vesicoureteral reflux were corrected by this method.


RESULTS
All patients were followed with ultrasound and voiding cystourethrography 3 and 9 months postoperatively. The diverticula with associated refluxing ureters were successfully cured. Neither postoperative recurrence nor ureteral obstruction were noted.


CONCLUSIONS
Extravesical diverticuloplasty can be performed for many sizes of paraureteral diverticula and concomitantly for the associated refluxing ureter, including refluxing duplex ureters.
Division of Pediatric Urology, Department of Urology, Chang Gung University School of Medicine, Chang Gung Children's Hospital at Kaohsiung, Kaohsiung, Taiwan, Republic of China.
Tsan Jung
TJ
Yu
D002675:Child, Preschool; D003558:Cystoscopy; D004240:Diverticulum / Q000150:complications / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D014513:Ureter / Q000000981:diagnostic imaging; D014515:Ureteral Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*