Laparoscopic cross-trigonal Cohen ureteroneocystostomy

Novel technique

Francesco Montorsi, Andrea Salonia, Tommaso Maga, Renzo Colombo, Andrea Cestari, Giorgio Guazzoni, Patrizio Rigatti

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Purpose: We describe a novel technique of laparoscopic transvesical cross-trigonal Cohen anti-reflux ureteroneocystostomy. Materials and Methods: A 10, an 11 and a 32-year-old patient with symptomatic unilateral vesicoureteral reflux underwent laparoscopic cross-trigonal ureteral reimplantation. Two 5 mm. balloon tip ports were suprapubically inserted into the bladder. Using a transurethral resectoscope with a Collins knife a 4 to 5 cm. cross-trigonal submucosal trough was created from the refluxing ureteral orifice to the contralateral side of the bladder. The refluxing ureteral orifice and intramural ureter were completely mobilized intravesically, advanced transtrigonally and secured to the detrusor muscle at the apex of the trough with 3 deep interrupted sutures. The elevated mucosal flaps of the trough were suture approximated over the ureter to create a submucosal tunnel. All suturing was performed by freehand laparoscopic technique. Results: Operative time was between 2.5 and 4.5 hours and blood loss was 10 to 50 cc. Adequate submucosal trough creation, ureteral extravesical mobilization and intravesical advancement, and bladder mucosal flap reapproximation were done to create a submucosal tunnel in all cases. Satisfactory transtrigonal anchoring of the neoureteral orifice to the detrusor muscle and mucosa was achieved with 3 stitches. Hospital stay was 2, 2 and 1 days in the 3 cases, and the Foley catheter remained in place for 3, 1 and 1 week, respectively. At 6 months reflux had resolved in 2 patients, while in 1 grade II reflux persisted, which was improved from grade IV preoperatively. All patients have remained infection-free without antibiotics. Conclusions: Laparoscopic transvesical cross-trigonal antireflux ureteral reimplantation is technically feasible. Intravesical laparoscopic suturing is possible. Potential advantages include a decreased hospital stay, decreased narcotic requirement and better cosmesis. Further experience is necessary to refine the technical nuances and evaluate outcomes compared to the open technique.

Original languageEnglish
Pages (from-to)1811-1814
Number of pages4
JournalJournal of Urology
Volume166
Issue number5
Publication statusPublished - 2001

Fingerprint

Urinary Bladder
Replantation
Ureter
Sutures
Length of Stay
Muscles
Vesico-Ureteral Reflux
antineoplaston A10
Narcotics
Operative Time
Mucous Membrane
Catheters
Anti-Bacterial Agents
Infection

Keywords

  • Laparoscopy
  • Ureter
  • Vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

Laparoscopic cross-trigonal Cohen ureteroneocystostomy : Novel technique. / Montorsi, Francesco; Salonia, Andrea; Maga, Tommaso; Colombo, Renzo; Cestari, Andrea; Guazzoni, Giorgio; Rigatti, Patrizio.

In: Journal of Urology, Vol. 166, No. 5, 2001, p. 1811-1814.

Research output: Contribution to journalArticle

Montorsi, F, Salonia, A, Maga, T, Colombo, R, Cestari, A, Guazzoni, G & Rigatti, P 2001, 'Laparoscopic cross-trigonal Cohen ureteroneocystostomy: Novel technique', Journal of Urology, vol. 166, no. 5, pp. 1811-1814.
Montorsi, Francesco ; Salonia, Andrea ; Maga, Tommaso ; Colombo, Renzo ; Cestari, Andrea ; Guazzoni, Giorgio ; Rigatti, Patrizio. / Laparoscopic cross-trigonal Cohen ureteroneocystostomy : Novel technique. In: Journal of Urology. 2001 ; Vol. 166, No. 5. pp. 1811-1814.
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AU - Rigatti, Patrizio

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AB - Purpose: We describe a novel technique of laparoscopic transvesical cross-trigonal Cohen anti-reflux ureteroneocystostomy. Materials and Methods: A 10, an 11 and a 32-year-old patient with symptomatic unilateral vesicoureteral reflux underwent laparoscopic cross-trigonal ureteral reimplantation. Two 5 mm. balloon tip ports were suprapubically inserted into the bladder. Using a transurethral resectoscope with a Collins knife a 4 to 5 cm. cross-trigonal submucosal trough was created from the refluxing ureteral orifice to the contralateral side of the bladder. The refluxing ureteral orifice and intramural ureter were completely mobilized intravesically, advanced transtrigonally and secured to the detrusor muscle at the apex of the trough with 3 deep interrupted sutures. The elevated mucosal flaps of the trough were suture approximated over the ureter to create a submucosal tunnel. All suturing was performed by freehand laparoscopic technique. Results: Operative time was between 2.5 and 4.5 hours and blood loss was 10 to 50 cc. Adequate submucosal trough creation, ureteral extravesical mobilization and intravesical advancement, and bladder mucosal flap reapproximation were done to create a submucosal tunnel in all cases. Satisfactory transtrigonal anchoring of the neoureteral orifice to the detrusor muscle and mucosa was achieved with 3 stitches. Hospital stay was 2, 2 and 1 days in the 3 cases, and the Foley catheter remained in place for 3, 1 and 1 week, respectively. At 6 months reflux had resolved in 2 patients, while in 1 grade II reflux persisted, which was improved from grade IV preoperatively. All patients have remained infection-free without antibiotics. Conclusions: Laparoscopic transvesical cross-trigonal antireflux ureteral reimplantation is technically feasible. Intravesical laparoscopic suturing is possible. Potential advantages include a decreased hospital stay, decreased narcotic requirement and better cosmesis. Further experience is necessary to refine the technical nuances and evaluate outcomes compared to the open technique.

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