Comparative Clinical Study Between Modified Ureteral Orthotopic Reimplantation And Cohen Method Under Pneumovesicum In Pediatric Patients With Hydroureteronephrosis

Purpose:To report our initial experience of a modified ureteral orthotopic reimplantation technique under pneumovesicum and compare the outcome of our technique versus Cohen technique under pneumovesicum for correcting primary obstructive megaureter(POM)or vesicoureteral reflux(VUR)in pediatric patients.Methods:46 patients(38 POM and 8 VUR,mean age 16.24±14.55 months)treated with modified ureteral orthotopic reimplantation(A group)and 43 patients(34 POM and 9 VUR,mean age 22.98±21.80 months)treated with the Cohen reimplantation(B group)under pneumovesicum.We compared the results in patients’ perioperative and follow-up conditions.Results:The mean operative time was significantly shorter in A group(A:86.86±16.37 and 108.18±15.70 for unilateral and bilateral versus B:95.14±8.58 and 124.29±13.97,min,p>0.05).The mean postoperative hospital stay(A:5.02±0.88 versus B:5.07±0.99,day,p>0.05),blood loss(A:3.67±0.90 versus B:3.84±0.81,ml,p>0.05)and follow-up time(A:POM 23.17±10.14 versus B:23.37±12.85,month,p>0.05)had no significant difference between two groups.There was one patient converted to open surgery in A group and no conversion in B group.Postoperative febrile urinary tract infection occurred in 2 cases in each group,all controlled by antibiotics.All patients in two groups showed improved hydroureteronephrosis and all VUR patients showed reflux resolution post surgery.Conclusions:Our modified ureteral orthotopic reimplantation technique under pneumovesicum can be performed safely and effectively,achieving a high success rate that is equivalent to Cohen technique under pneumovesicum but with simpler procedure and shorter operation time.