Modified Leadbetter-Politano Ureteroneocystostomy: A Safer Procedure
Urology Journal,
Vol. 17 No. 05 (2020),
30 October 2020
,
Page 501-504
https://doi.org/10.22037/uj.v17i05.5709
Abstract
Purpose:
Open surgical reimplantation of ureters is a highly successful procedure, with reported correction rates of 95 to 99 percent regardless of the severity of vesicoureteral reflux (VUR). Leadbetter-Politano ureteroneocystostomy is one of the most preffered technique for open ureteroneocystostomy.
The authors report the modified Politano-Leadbetter technique with extravesical mobilization and transection of the ureter at the level of ureterovesical junction and intravesical reimplantation.
Materials and Methods:
Fifty-seven children with unilateral VUR, underwent modified Leadbetter-Politano ureteral reimplantation with extravesical mobilization and transection of the ureter at the level of ureterovesical junction and intravesical reimplantation. Persistence of VUR despite endoscopic correction, breakthrough infections, complications due to antibiotics, progressive renal scarring, reflux nephropathy, and parental preference were indications for open reimplantation. Operations were done by two full-time pediatric surgeons. Operation time and hospital stay of the patients, reflux persistency, voiding dysfunction and complications were recorded.
Results:
No ipsilateral VUR was detected postoperatively. Mean operation time was 76.54 min (±8.76 min; range, 70-86 min) Mean duration of the hospital stay is 82.31 h (±9.78 h; range, 71-93 h). Postoperative gross hematuria was not seen in any patients. No voiding dysfunction and no late complications was encountered.
Conclusions:
Modified Leadbetter-Politano technique is a good option to treat VUR with success rate up to 100% without any major complicatons such as viscus perforation and ureteral obstruction. It is a rather simple technique that require less operative time.
- Vesicoureteral reflux
- ureteroneocystostomy
- ureter
- pediatric
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References
Kennelly MJ, Bloom DA, Ritchey ML, Panzl AC. Outcome analysis of bilateral Cohen cross-trigonal ureteroneocystostomy. Urology. 1995;46:393-5.
Ellsworth PI, Merguerian PA. Detrusorrhaphy for the repair of vesicoureteral reflux: comparison with the Leadbetter-Politano ureteroneocystostomy. J Pediatr Surg. 1995;30:600-3.
McLorie GA, Jayanthi VR, Kinahan TJ, Khoury AE, Churchill BM. A modified extravesical technique for megaureter repair. Br J Urol. 1994;74:715-9.
Barrieras D, Lapointe S, Reddy PP, Williot P, McLorie GA, Bigli D, Khoury AE, Merguerian PA. Are postoperative studies justified after extravescial ureteral reimplantation? J Urol. 2000;164:104-6.
Hubert KC, Kokorowski PJ, Huang L, Prasad MM, Rosoklija I, Retik AB, Nelson CP. Clinical outcomes and long-term resolution in patients with persistent vesicoureteral reflux after open ureteral reimplantation. J Urol. 2012;188:1474-9.
Diamond DA, Mattoo TK. Endoscopic treatment of primary vesicoureteral reflux. N Engl J Med. 2012; 366:1218-26.
Austin JC, Cooper CS. Vesicoureteral reflux:Surgical approaches. Urol Clin N Am 2004; 31:543-57
Heidenreich A, Özgür E, Becker T, Haupt G. Surgical management of vesicoureteral reflüx in pediatric patients. World J Urol 2004; 22:96-106
Dietz HG, Schmidt A, Bader JB, Markus A. The Politano-Leadbetter Antireflux Plasty: Investigation of complications in 245 children. Eur J Pediatr Surg 1996; 6:277-280
Akiyama T, Boku E, Kunikata S, Kaneko S, Kurita T, Uemura T, Kataoka T. Viscus perforation as an unusual complication of Politano-Leadbetter ureteral reimplantation. Hinyokika Kiyo. 1987; 33:864-8
Dern PO, Storz R, Frankenschmidt A. 874 Complications after Politano-Leadbetter ureteral reimplantation. European Urology Supplements. 2009; 8:339
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