Novel technique of laparoscopic extravesical ureteric reimplantation in primary obstructive megaureter

摘要

OBJECTIVE: This study aims to demonstrate a novel laparoscopic technique of tapering megaureter without disrupting the blood supply and disconnecting the ureter. MATERIALS AND METHODS: Eight cases of primary obstructive megaureter in the age group of 14-22 years underwent laparoscopic extravesical ureteric reimplantation between August 2011 and July 2015 using our novel technique. Five patients had obstruction on left side and three on right side. Follow-up ultrasonography at 1 month and 3 months, voiding cystourethrogram (VCUG) at 3 months and intravenous urogram (IVU) at 6 months was obtained to assess the development of reflux and to look for adequate drainage of the obstructive ureter. RESULTS: Average age of the patients at the time of surgery was 18.5 years. Mean operating time was 95 min. Mean blood loss of 20 ml. VCUG done after 3 months showed no reflux in all cases. IVU done after six months showed no obstruction and complete drainage of dye. CONCLUSION: Our technique of tapering obstructed megaureter over a preplaced ureteral dilator is time saving and also helps in preserving blood supply to lower ureter. As a result, ureteric anastomotic stricture rate is very low. It is easily reproducible in the open as well as by robotic.