Salvage Extravesical Ureteral Reimplantation After Failed Endoscopic Surgery For Vesicoureteral Reflux

December 15, 2006 – 3:46 pm | posted in Urology / Nephrology

UroToday.com - After failed injection therapy with dextranomer/hyaluronic acid, open transvesical ureteral reimplantation seems to be successful and not too technically challenging. Elmore et al report the first study on the extravesicle approach regarding ureteral reimplantation following this injection therapy failure.

They reviewed the charts of 30 patients who underwent extravesical ureteral reimplantation after dextranomer/hyaluronic acid failure. If reflux was initially bilateral and only a unilateral cure was achieved, the cured ureter was not reimplanted. Intraoperative complications, need for stenting or prolonged bladder catheterization, length of hospitalization and radiographic results were evaluated.

They found that in half of the patients at cystoscopy, the dextranomer/hyaluronic acid implants were not identifiable. In the remaining 15 patients the blebs had moved caudally and/or were seen extravesically at the ureteral hiatus or along Waldeyer’s sheath. Unilateral extravesical ureteral reimplantation was performed without difficulty in all patients and there were no intraoperative complications. Stents were left indwelling only in those patients who had undergone dismembered ureteral reimplantation. No patient required prolonged bladder drainage. 28 patients were discharged home within 24 hours postoperatively. The remaining 2 had a concomitant procedure. There was no evidence of obstruction on postoperative renal sonography, and extravesical ureteral reimplantation was confirmed to be successful in all 24 patients with postoperative voiding cystourethrograms.

The group concluded that extravesical ureteral reimplantation can be performed without difficulty following dextranomer/hyaluronic acid implantation failure and seems to be an excellent treatment option. I agree that an extravesicle approach is optimal in this setting, and in experienced hands can be performed laparoscopically just as well with a less than 24 hour hospital stay.

Elmore JM, Kirsch AJ, Perez-Brayfield MR, Scherz HC, Koyle MA

. Journal of Urology 176(3): 1158-1160, September 2006.
Reviewed by UroToday.com Medical Editor Pasquale Casale, MD

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