Simple Operative Repair of Ureterocele (Ureterocelorrhaphy)

Vol. 106, July

THE JOURNAL OF UROLOGY

Copyright© 1971 by The Williams & Wilkins Co.

Printed in U.S.A.

SIMPLE OPERATIVE REPAIR OF URETEROCELE (URETEROCELORRHAPHY) TATE MASON From ihe Department of Urology, The Mason Clinic, Seattle, Washington

Ureteroceles less than 0.5 cm. in diameter which are asymptomatic and non-obstructing should be managed conservatively. However, if a

oceles should be approached transvesically; several alternate methods of management have been reported previously. The ideal procedure

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patient has pain, obstruction and, perhaps, mfection an operation is indicated. There is a high incidence of reflux when large ureteroceles (more than l.v cm. in diameter) are treated by transurethral methods. Large ureter-

should eradicate the ureterocele, prevent reflux and not obstruct the distal ureter. Hutch and Chisholrr. note that "surgical procedures commonly used for the correction of ureterocele destroy or weaken the roof of the intravesical ureter" .1 Hutch2 along with Paquin, 3 Politano

Accepted for publication November 1970. Read at annual meet;ng of Western Section, American Urological Association, Phoenix, Arizona, April 12--17, 1970.

1 Hutch, J. A. and Chisholm, E. R.: Surgical repair of ureterocele. J. Urol., 96: 445, 1966. 2 Hutch, J. A.: Vesico-ureteral reflux in the

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URETEROCELORRHAPHY

FIG. 2

and Leadbetter, 4 as well as others, have demonstrated the importance of the oblique submucosal passage of the ureter to the trigone in preventing reflux. A technique of ureterocele repair is herein described which is simple, reestablishes the submucosal tunnel and appears to fulfill the criteria for a successful ureterocele repair. OPERATIVE TECHNIQUE

The ureterocele is exposed through a transvesical approach. The proximal and distal ends of the ureterocele are identified-·and a traction suture is placed at the proximal end (fig. 1, No attention is given to the ureteral orifice since it is removed with the specimen. With tension on the -"""'~.,, placed suture, the ureterocele is paraplegic: cause and correction. J. Urol., 68: 457, 1952. 3 Paquin, A. J., Jr.: Considerations for the management of some complex problems for ureterovesical anastomosis. Surg., Gynec. &

Obst., 1:18: 75, 1964. 4 Politano, V. A. and Leadbetter, W. F.: An operative technique for the correction of ves1eoureteral reflux. J. Urol., 79: 932, 1958.

simply excised near its base (fig. 1, After the ureterocele is opened there is a gush of urine under pressure. At this stage of the floor of the ureterocele and usually patent u.reteral orifice are easily identifiable (fig. 2, A). Bleeding is minimal, if any. An SF catheter is passed up the ureter to sure its patency and the bladder mucosa is undercut for about 0.5 cm. on the superior, medial and lateral sides of the ureterocelectomy (fig. 2, If there is any defect in the posterior wall of the bladder behind the ureterocele it can be by lifting the posterior wall of the ureterocele from its attachment and approximating the bladder muscle behind it. The posterior ureterocele wall should not be detached from the ureter. In our first few cases we have not found it necetJsary to detach the posterior ureterocele wall. The posterior wall is then used as the first of a 2-layer closure forming a tu.be over the ureteral catheter. For closure, 4-zero chromic catgut on a traumatic needles is used (fig. 3, .A). This layer contains muscle and is covered with transi0

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tional cell epithelium. The second layer is closed by bringing the cut edges of the undercut bladder mucosa across the newly formed ureteral tube (fig. 3, B). The ureteral meatus is fashioned by interrupted sutures between the bladder mucosa and the distal end of the ureteral tube (fig. 3, G), and is made snug around the SF catheter. Upon completion of the tunnel, the length equals the diameter of the removed ureterocele (fig. 4). The ureteral catheter is removed before the bladder is closed. The bladder is closed in the usual manner with a urethral catheter left indwelling for 7 to 8 days. SUMMARY

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A simple method for repair of intravesical ureterocele using the principle of the submucosal tunnel is presented. Preliminary results of the procedure have proved it workable without serious complication. Further clinical trial is indicated.