First expirience of laparoscopic extravesical ureteral reimplantation in primary obstructive megaureter

Surgery is the ultimate treatment for primary obstructive megaureter in cases where conservative treatment fails. Objective of the research: to describe the initial experience of primary obstructive megaureter treatment with laparoscopic extravesical ureteral reimplantation as an alternative to open surgery. Material and methods: in the period from 2018 to 2019, a total of 9 patients underwent successful laparoscopic treatment of the primary obstructive megaureter, which consisted in laparoscopic reimplantation of 11 ureters in the style of the Lich-Gregoir operation, improved in the walls of our hospital. Improvements related to performing cystoscopy and submucosal injection of hydroxyethyl starch solution before surgery to facilitate the creation of a submucosal tunnel and the application of several transparietal anchor sutures to the detrusor. Postoperative follow-up included ultrasound of the kidneys and bladder, cystography, and radionuclide renography, which were performed 6 months after surgery. In the final part of the study, a statistical analysis of the morphometric and functional results of the operations was performed. Results: all surgical operations were successfully completed without conversion to open procedures. The average duration of the operation was 112,5 minutes. The average length of hospital stay was 4,5 days. Postoperative radioisotope renography showed non-obstructive renal function in all patients. Statistical analysis revealed significant differences in pre-and postoperative parameters that evaluate the size of the operated ureter and renal blood flow. The diameter of the distal part of the ureter decreased on average from 18,7 mm to 3,9 mm. The resistive index decreased from 0,74 to 0,66. In the early observation period, no urinoma formation or cases of vesicoureteral reflux were noted. Differentiated renal function increased from 36,8% to 46,8%. All 9 patients were asymptomatic following follow-up for an average of 12 months. Conclusion: laparoscopic extravesical ureteral reimplantation is a safe and effective treatment option for primary obstructive megaureter. In order to understand the role of this method, comparative studies and long-term follow-up of patients after surgery are necessary.