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VESICO-RENAL   REFLUX   IN   ADULTS

OPERATIVE   TECHNIQUE

Basic principles  ( A )

 

The aim of the operation is to restore the normal function of the interureteric bar  in order to prevent sliding of ureters outwards during voiding.

The standard Cohen operation for children is build to  the same purpose : both terminal ureters are laid down side by side in a submucosal groove and stability is held by scar adherences.

In adult women this procedure may fail by shortage of  ureters and this building entails a major criticism as impeding further ureter catheterisation.

1) Terminal ureters are freed as far as they move easily within the bladder wall.

2) Both ureteric outlets are joined by submucosal tunnelling. Left and right tunnel legs start from a medan sagittal incision.

3) Both ureteral extemities are sutured end to end on the posterior half of their circumference and the anterior halves are tied to the surrounding mucosa and the underlying muscular layer.

4) Before closing the lateral incisions, the surgeon verifies and strengthens by resuturing if necessary the fibrous underlying contention fascia.

 

Catheters, sutures and minor details are always preferences of the operating surgeon.

 

Feasibility

 

When ureters are too long and fall sock-sagging they may be shortened . Extremity resection implies no healing complication ; on the contrary terminal centimeters  are often long time infected and devitalized. ( B )

 

Too short ureters surrounded by a stiff inflammatory sheath are rather uncommon.

This appears at first sight.   The surgeon can delimit left and right extension straps from the whole bladder wall thickness to be joined end to end. (C )

 

Evolution

Have no fear that the new ureteric outlets remain too closely face to face.  Physiological  muscle  strains  replace  them   automatically  in normal  position.

 

         Additional operations

In this 177 operated on patients series, were performed as complementary interventions :

 

              16   for    stress incontinence

                7   for     redundant hymeneal fringes

                2  for      hysterectomy

                2  for      E.C. Lithotrity

                1  for      pyelo-ureteric junction syndrome

                1  for      bladder neck  syndrome

                1  for      urethral diverticula plasty

                1  for      urethral stricture enlargement

 

Introduction
Etiology & Pathology
Results & Evaluation
Diagnosing adult reflux by radioactive isotopes