ENDOSCOPIC TRIGONOPLASTY II FOR PRIMARY VESICO-URETERAL REFLUX

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  • 原発性膀胱尿管逆流症に対する内視鏡下三角部形成術II
  • 原発性膀胱尿管逆流症に対する内視鏡下三角部形成術2
  • ゲンパツセイ ボウコウ ニョウカン ギャクリュウショウ ニ タイスル ナイシキョウ カ サン カクブ ケイセイジュツ 2

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Abstract

(Purpose) We report a technique and outcome of endoscopic trigonoplasty II (ET II), antireflux surgery via a transvesicostomy transurethral approach and discuss its usefulness.<br>(Materials and methods) Fifteen female patients, aged 5 to 64, with 23 refluxing ureters (grade I:5, II:2, III:14, IV:2) underwent the ET II. The principle of this surgery is tightening the muscular backing and elongating the intramural ureter. The operation consists of three steps: 1) two 5mm locking trocars are placed into the bladder, 2) irrigating with 3% D-sorbitol solution, the bladder wall is incised upward along each side of the ureter using a resectoscope, to make a 2 to 3cm U-shaped bladder flap including the ureter, 3) under a pneumobladder, the incised wall is sutured to make a muscular bed with a needle-holder via the urethra and forceps via the abdominal trocar. The U-shaped flap is fixed with two distal anchor sutures and four additional mucosal sutures. Urethral catheter is indwelled and the operation is finished. In recent four cases, we closed the tracts endoscopically.<br>(Results) The average operative time was 144 minutes per ureter. In one patient with unilateral reflux, we switched to open surgery because of bleeding. Of 22 refluxing ureters, the reflux disappeared in 18 ureters (82%) and improved grade III to I in 1 ureter (5%) after 3 months and disappeared in 19 ureters (86%) after 12 months postoperatively. Ureteral injury was occurred in 3 patients during the transurethral incision of the bladder. Though we repaired it by placing a double-J stent in the 2 patients, reflex recurred in 12 months postoperatively in one of them. In the other patient cystoscopy revealed a vesicoureteral fistula in the injured portion. She subsequently underwent successful open Politano-Leadbetter ureteroneocystostomy. The average duration of indwelling catheter was shortened from 4.3 to 3.0 days by closing the tracts endoscopically.<br>(Conclusions) The overall cessation rate of the ET II was inferior to those of open anti-reflux surgeries or laparoscopic extravesical ureteral reimplantation. We do not recommend ET II for vesicoureteral reflux.

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