A modified technique for ureteral reimplantation: intravesical detrusorrhaphy.
OBJECTIVE
To describe the surgical procedure of intravesical detrusorrhaphy, a modified technique of ureteral reimplantation, and report our initial experience.


METHODS
From October 2007 to March 2012, 55 children with vesicoureteral reflux (VUR) and 13 children with obstructive megaureter (OM) underwent intravesical detrusorrhaphy. All surgical procedures were performed via an open intravesical approach. The ureter was mobilized, and the bladder mucosa was separated from the detrusor in a cephalad direction. The separated detrusor was incised vertically and repaired underneath the mobilized ureter to create the submucosal tunnel. The ureteral orifice was anastomosed to its orthotopic position.


RESULTS
Of 31 patients treated with bilateral intravesical detrusorrhaphy, no patient had postoperative urinary retention. Follow-up voiding cystourethrography was performed in 45 patients with 72 reimplanted ureters. VUR was resolved in 41 patients (91.1%) with 68 ureters (94.4%). Among 13 patients with 14 ureters treated for OM, hydroureteronephorosis improved in 11 patients (84.6%) with 12 ureters (85.7%).


CONCLUSIONS
Intravesical detrusorrhaphy is modified technique of ureteral reimplantation, which recreates the neo-ureteric orifice in the orthotopic position and does not produce postoperative urinary retention in bilateral cases. Intravesical detrusorrhaphy is safe and effective in treating patients with VUR or OM.
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul 120-752, Korea.
Kwang Hyun
KH
Kim
Yong Seung
YS
Lee
Young Jae
YJ
Im
Cho Nyeong
CN
Lee
Sang Won
SW
Han
D000714:Anastomosis, Surgical; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000601:surgery; D007223:Infant; D008297:Male; D009092:Mucous Membrane / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000601:surgery
Replantation; Ureter; Urinary bladder; Vesico-ureteral reflux