A Novel Modification of Ureteral Reimplantation (Combined Technique) in Pediatric Patients: A Preliminary Case Series.

Background: In this video, we present a new open ureteral reimplantation approach (combined technique) with preliminary results from 32 renal units.

Material and methods: Written informed consent was obtained from the parents of the patients. We used a suprapubic Pfannenstiel incision to reach the bladder. After preparation of the ureters with the guidance of the vesicoureteral reflux surgery principle, they were moved from the bladder to the extravesical area. A submucosal tunnel was created above and below the old hiatus with reference to the old hiatus site. The required submucosal tunnel length is adjusted to be 2/3 above the old hiatus and 1/3 below the old hiatus. The ureters were carried down through the submucosal tunnel using a right-angle clamp and fixed to the bladder with 5/0 polyglactin sutures, step by step, respectively.

Results: A total of 22 patients (9 females/13 males) with a median age of 7 (min: 2and max: 15) years were operated on using the combined technique. There were 16 cases with vesicoureteral reflux and 6 cases with unilateral obstructive megaureter. The success rate was found to be 100% for vesicoureteral reflux and 83.3% for primer obstructed megaureter. When we focus on the number of ureters, the overall success rate was found to be 97%.

Conclusion: The vertical angulation or kinking of the ureter at the entrance to the bladder can be prevented in this modification. New orifice localization is close to the normal position. Short tunnel length is out of the question in this modification. We think that with potential surgical advantages, a novel combined technique can be used in ureteral reimplantation.