Our Summary

This research paper is about a surgical technique used to treat a condition in children called primary obstructive megaureter (POM) - a large, blocked ureter (the tube that carries urine from the kidneys to the bladder). The technique is called pneumovesicoscopic ureteral reimplantation and involves altering the size of the ureter inside the bladder.

Between 2014 and 2020, the researchers performed this surgery on 42 children (average age: 3.1 years). They specifically analyzed 9 cases where the ureter was extremely large (diameter > 25 mm) and needed to be resized. For these procedures, they used a special technique that involves fixing the ureter in place using a loop. This makes the resizing process easier and less traumatic for the ureter.

The average operation time was about 142 minutes, and the resizing process took about 18 minutes. After the surgery, the children’s kidney function didn’t decrease. In fact, three patients even saw an average kidney function improvement of 7%.

All patients were examined 1-3 weeks and 3-6-12 months after the surgery, and in most cases, the size of the ureter and kidney pelvis (the part of the kidney where urine collects) decreased. Eight patients had no symptoms after the surgery, while one showed no improvement and required further treatment.

The researchers conclude that their technique, which uses a specific type of needle (Tuohy needle) and a loop, makes the surgical treatment of POM easier, faster, and less traumatic for the ureter. They suggest that their technique could be beneficial in other studies and that using an external stent (a tube used to support the ureter) for a month after the surgery could help prevent blockage and reduce post-surgery urinary tract infections.

FAQs

  1. What is the surgical technique used to treat primary obstructive megaureter (POM) in children?
  2. What were the results of the surgeries performed using the pneumovesicoscopic ureteral reimplantation technique?
  3. Why do the researchers suggest using an external stent after the surgery?

Doctor’s Tip

A helpful tip a doctor might give a patient undergoing ureteral reimplantation is to make sure to follow all post-operative instructions carefully, including taking any prescribed medications, attending follow-up appointments, and avoiding strenuous activities that could put strain on the surgical site. It is also important to stay well-hydrated and to report any unusual symptoms or signs of infection to the healthcare provider promptly.

Suitable For

Patients who are typically recommended for ureteral reimplantation are those with primary obstructive megaureter (POM), especially those with extremely large ureters (diameter > 25 mm) that need to be resized. In the study mentioned above, the average age of the children who underwent this surgery was 3.1 years. Other potential candidates for ureteral reimplantation may include patients with recurrent urinary tract infections, kidney stones, or other conditions affecting the ureters. Ultimately, the decision to recommend ureteral reimplantation will depend on the specific circumstances of each individual patient and should be made by a qualified healthcare provider.

Timeline

Before the ureteral reimplantation surgery, a patient with primary obstructive megaureter may experience symptoms such as recurrent urinary tract infections, abdominal pain, and difficulty urinating. They may undergo various tests such as ultrasounds, CT scans, and urodynamic studies to diagnose the condition.

During the surgery, which typically lasts around 142 minutes, the ureter is resized using a loop technique, with the resizing process taking about 18 minutes. After the surgery, patients are monitored closely for kidney function and symptom improvement.

1-3 weeks after the surgery, patients are examined to assess the size of the ureter and kidney pelvis. Over the following months (3, 6, and 12), further examinations are conducted to evaluate the effectiveness of the surgery. In most cases, the size of the ureter and kidney pelvis decreases, and kidney function remains stable or improves.

Overall, the researchers found that their pneumovesicoscopic ureteral reimplantation technique using a loop and Tuohy needle was successful in treating primary obstructive megaureter in children. They suggest that their technique could be beneficial in other studies and recommend the use of an external stent post-surgery to prevent blockage and reduce urinary tract infections.

What to Ask Your Doctor

  1. What is primary obstructive megaureter (POM) and why is ureteral reimplantation necessary for its treatment?
  2. How does pneumovesicoscopic ureteral reimplantation differ from traditional ureteral reimplantation techniques?
  3. What are the potential risks and complications associated with ureteral reimplantation surgery?
  4. How long is the recovery period after pneumovesicoscopic ureteral reimplantation surgery?
  5. Will I need to follow any specific post-operative care instructions or restrictions?
  6. How will my kidney function be monitored following the surgery?
  7. Are there any long-term effects or considerations to be aware of after undergoing ureteral reimplantation?
  8. What are the success rates of this surgical technique, particularly in cases where the ureter needs to be resized?
  9. Are there any alternative treatment options available for primary obstructive megaureter?
  10. How frequently will follow-up appointments be needed after the surgery?

Reference

Authors: Rudin YE, Marukhnenko DV, Galitskaya DA, Aliev JK, Lagutin GV, Vardak AB. Journal: J Pediatr Urol. 2022 Apr;18(2):224.e1-224.e8. doi: 10.1016/j.jpurol.2021.12.004. Epub 2021 Dec 11. PMID: 34991990