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| The anti-reflux effectiveness of direct ureteral nipple in laparoscopic ureteral reimplantation |
| BAI Zunguang WANG Zhaohui DAI Ruixin ZHU Shoulun PAN Jun WU Tao |
| Department of Urology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong Province, Guangzhou 510120, China |
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Abstract Objective To explore the anti-reflux effectiveness of direct ureteral nipple in laparoscopic ureteral reimplantation. Methods Thirteen patients (14 sides) underwent laparoscopic direct nipple ureteroneocystostomy. In each case, the lower end of the ureter was freed and delivered out of the peritoneal cavity through the ipsilateral trocar. Then the lateral ureter was tailored and folded back onto itself approximately 1 cm to make into nipple evaginated mode. A double-J stent was placed in the ureter and replaced in the abdomen. The posterolateral wall of bladder was opened. Then the nipple and double-J stent were placed into the bladder lumen and a mucosa-to-full thicknessanastomosis was made. Results Surgery was successful in all 13 patients. 13 sides monitored with cystourethrography and cystoscopy did not demonstrate vesicoureteral reflux. Cystoscopy revealed the intravesical nipple was 0.8-1.0 cm long. The shape of nipple was regular without depression and atrophy. But 1 case was revealed with third-degree reflux. Cystoscopy revealed the shape of nipple was irregular with partial depression and atrophy. The nipple remained open during the bladder-filling period. The median follow-up was 24 months (6-63 months). No patients showed the improvement of hydronephrosis or ureterectasia on ultrasound. No patients occurred acute pyelonephritis or the symptom of backache. Conclusion Laparoscopic ureteral reimplantation with direct ureteral nipple shows effective anti-reflux effectiveness. It is relatively easy to operate during the process to implant the nipple and worthy of being widely applied in clinic. However, such technical issues need to be standardized.
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