A new endoscopic ureteral reimplantation for primary vesicoureteral reflux (endoscopic trigonoplasty II).
OBJECTIVE
We describe a new technique of endoscopic antireflux surgery. The principle of the procedure is to make a reliable muscular backing and elongate the intramural ureter.


METHODS
We performed this new endoscopic surgery in 8 female patients in whom 4, 1, 8 and 1 refluxing ureters (total 14) were diagnosed with grades I to IV reflux, respectively. The operation consists of 3 steps. Two 5 mm. locking trocars are placed into the bladder. Irrigation is done with 3% D-sorbitol solution and the bladder wall is incised upward along each side of the ureter using a resectoscope to make a 2 to 3 cm. U-shaped bladder flap, including the ureter. Under pneumobladder the incised muscle is sutured to make a muscular bed with a needle holder via the urethra and forceps via the abdominal trocar. The U flap is fixed with 2 distal anchor sutures on the embedded muscular layer and 4 additional sutures are placed to approximate the mucosa of the U-shaped flap and bladder.


RESULTS
Mean operative time was 245 minutes. Ureteral injury occurred in 2 patients. A Foley catheter remained indwelling for 3 to 5 days (mean 4.1). Reflux resolved in 12 of the 14 ureters (86%) 12 months postoperatively. Vesicoureteral reflux persisted in 1 case because of insufficient fixation and recurred in 1 because of ureterovesical fistula. The patients were satisfied with better cosmesis and minimal postoperative discomfort.


CONCLUSIONS
We believe that procedure is feasible for female patients with primary vesicoureteral reflux.
Tsuji
Yoshikazu
Y
Department of Urology, Chukyo Hospital, Nagoya, Japan.
Okamura
Kikuo
K
Nishimura
Tatsuya
T
Okamoto
Noriko
N
Kobayashi
Mineo
M
Kinukawa
Tsueno
T
Ohshima
Shinichi
S
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*