title: Laparoscopic reconstruction for obstructive megaureter: single institution experience with short- and intermediate-term outcomes.
abstract: OBJECTIVE
  To narrate our experience with laparoscopic reconstruction of obstructive megaureter (MGU) and assess the intermediate-term outcome achieved.
  
  
  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/m(2). 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.
  
  
  CONCLUSIONS
  Laparoscopic reconstruction of obstructive MGU offers satisfactory immediate- and intermediate-term outcome without undue prolonged morbidity.
authors.affiliation: Department of Urology, Lakeshore Hospital and Research Centre, Maradu, Kochi, India.
authors.forename: George P
authors.initials: GP
authors.lastname: Abraham
authors.forename: Krishanu
authors.initials: K
authors.lastname: Das
authors.forename: Krishnamohan
authors.initials: K
authors.lastname: Ramaswami
authors.forename: Avinash T
authors.initials: AT
authors.lastname: Siddaiah
authors.forename: Datson
authors.initials: D
authors.lastname: George
authors.forename: Jisha J
authors.initials: JJ
authors.lastname: Abraham
authors.forename: Oppukeril S
authors.initials: OS
authors.lastname: Thampan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult