Ureteral reimplantation: Cross-trigonal approach

Section Editor's note: 'Y'tube, a video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men's health. 'Y'tube covers surgical aspects of a variety of men's health issues with the ultimate goal of accumulating a library of videos to serve as a reference. This installment looks at ureteral reimplantation. Typically done for vesicoureteral reflux, iureteral reimplantation is one of the most common major procedures in pediatric urology. Its use in the adult population, however, is rare. Often, urologists are called in to perform a ureteral reimplant due to iatrogenic trauma, or the procedure is done as part of other reconstructive urologic surgeries in the care of pediatrics patients with spina bifida transitioning to adult care. The use of meticulous tissue handling and tips and tricks for a seamless and efficient ureteral reimplant serve as a reference for any ureteral surgery as well as a reminder of what adult urologists may encounter on caring for these young adults transitioning out of pediatric urologic care.

The Cohen cross-trigonal ureteral reimplant is perhaps the most commonly performed open reimplant procedure, particularly for correcting bilateral vesicoureteral reflux. Its high success rate and low complication rate have made it a reliable surgery for over 40 years. A criticism of the technique is that it renders future retrograde access to the ureters extremely difficult. Subtle variations in surgical technique and postoperative management are found among different pediatric urologists, such as the need for stents or catheter drainage, but the basic surgical principles are presented here.

Dr. Hotaling: Drs. Wallis, Lau, and Cartwright demonstrate how to perform a complex procedure through a small, carefully placed incision. They use meticulous tissue handling and clear identification of tissue planes to identify, mobilize, and move the ureters. These techniques are broadly applicable to any ureteral surgery and serve to provide a safe and clear approach to intravesical ureteral identification and mobilization.

More 'Y'tube videos:

Ureteral reimplantation: Top-down approach

Robotic cystectomy: Intracorporeal neobladder using Studer technique

Vasectomy: A different approach to isolating the vas
 

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