Technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy

Abstract

Aim:To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy.Materials and Methods:Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status.Results:At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one.Conclusions:The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

Study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters

“…Various surgical techniques described by Hutch[ 1 ] , Cohen[ 14 ] , Leadbetter Politano[ 2 ] , Gregoir[ 5 ] , Glenn [ 6 ] , Gil-Vernet[ 7 ] , O Donnel et al [ 8 ] , Gupta et al [ 11 ] , Sunil et al . [ 12 ]…”

“…Various techniques of surgical correction of vesicoureteric reflux have been described. [ 1 2 3 4 5 6 7 8 9 10 11 12 ] The described techniques necessitate mobilization of ureters and its advancement either submucosal or extramucosal to create intravesical oblique course with detrusor backup for effectivity of Paquin's rule. [ 3 ] In some techniques for correction of vesicouretral reflux like endoscopic injection of dextranomer hyaluronic acid at the ureteric orifice[ 8 ] or extravesical ureteric reimplantation[ 4 5 ] , ureteric mobilization is not necessary.…”