Antonio Marte
Aims: The aim of this study is to describe vesicoscopic technique in the treatment of congenital bladder diverticula and vesicoureteral reflux (VUR) in children.
Patients: With the vesicoscopic technique, 58 patients havebeen treated at our Institution from January 2007 to January 2013. There were 13 pts with congenital bladder diverticula and 45 pts with persistent grade ≥ 3 VUR. Under cystoscopic control, three trocars were placed (one at bladder dome, two laterally). The reimplantation was implemented using Cohen’s technique. In case of megaureter, the ureter was brought out the bladder and tailored. The diverticula were inserted into the bladder progressively and then removed.
Results: Operating time ranged from 50 to 240 minutes. Three patients developed mild suprapubic emphysema after surgery. No patient was converted to open surgery or needed additional trocars. Renal scan with MAG3, VCUG and ultrasound performed in all patients 3 to 6 months after surgery showed the resolution of reflux in 31 out of 33 patients: an asymptomatic monolateral 1st grade reflux persisted in one girl who had been treated for monolateral 4th grade reflux, and in one boy with refluxing megaureter. All patients with diverticula presented full resolution.
Conclusion: Our experience seems to show that the vesicoscopic treatment of bladder diverticula, vesicoureteral reflux and megaureter is safe andeffective and can represents a new viable alternative to the traditional procedures.