title: A new endoscopic ureteral reimplantation for primary vesicoureteral reflux (endoscopic trigonoplasty II).
abstract: 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.
authors.affiliation: Department of Urology, Chukyo Hospital, Nagoya, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishimura
authors.forename: Noriko
authors.initials: N
authors.lastname: Okamoto
authors.forename: Mineo
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Tsueno
authors.initials: T
authors.lastname: Kinukawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohshima
mesh_terms: 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*