Outcome analysis of Cohen’s cross trigonal ureteric reimplantation in paediatric age group
Abstract
Introduction: Cohen’s cross trigonal ureteric reimplantation is the gold standard for surgical management of vesicoureteric reflux (VUR) in children with high success rate. The objective of this study was to evaluate and assess the outcome of open Cohen’s procedure in children with VUR.Methods: A retrospective review of all patients with VUR who underwent Cohen’s procedure between March 2010 and February 2020 was done. The following were recorded for each patient: age, sex, grade of reflux, operative time, outcome and complications.
Results: The series consisted of 40 patients (25 girls and 15 boys) who underwent Cohen’s procedure with a mean age of 32 months (6 months to 8 years). Bilateral repairs were performed in 16 patients (40%) in the same setting and unilateral repair in 24 patients (60%). Twenty-two patients (55%) had grade IV VUR, 13 patients (32.5%) had grade V VUR and 05 patients (12.5%) had grade III VUR. Mean operative time for bilateral repairs was 249.4(200-290) minutes and 158.3(130-180) minutes for unilateral repair respectively. The mean length of hospital stay was 10.55 (7-15) days. Major complications included two persistent VURs, and one case of bladder hematoma. Postoperative ultrasound abdomen in all patients and micturating cystourethrogram in few patients was obtained, in which 38 patients (95%) had normal study.
Conclusion: Cohen’s uretric reimplantation is a standard procedure in paediatric VUR. For better outcome, patient selection and refinement of operative technique should be pursued.
References
1. Kirsch AJ, Arlen AM, Lackgren G. Current trends in dextranomer hyaluronic acid copolymer (Deflux) injection technique for endoscopic treatment of vesicoureteric reflux. Urology. 2014 Aug 1;84(2):462-8.
2. Lau G, Anderson R, Cartwright P, Wallis MC, Schaeffer A, Oottamasathien S, Snow B. Unilateral open extravesical ureteric reimplanation with contralateral dextronomer/hyaluronic acid injection performed as an outpatient therapy. Journal of pediatric urology. 2018 Dec 1;14(6):566-e1.
3. Jayanthi V, Patel A. Vesicoscopic ureteric reimplantation: a minimally invasive technique for the definitive repair of vesicoureteric reflux. Adv Urol. 2008;2008:973616.
4. Chertin B, Kocherov S, Chertin L, Natsheh A, Farkas A, Shenfeld OZ, Halachmi S. Endoscopic bulking materials for the treatment of vesicoureteric reflux: a review of our 20 years of experience and review of the literature. Adv Urol. 2011;2011: 309626.
5. Callewaert P.R.H ‘What is new in surgical treatment of vesicoureteric reflux?’ Eur J Pediatr. 2007 Aug; 166(8): 763–8.
6. Chung JM, Park CS, Lee SD. Postoperative ureteric obstruction after endoscopic treatment for vesicoureteric reflux. Korean journal of urology. 2015 Jul 1;56(7):533-9.
7. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. Pediatric radiology. 1985 Feb 1;15(2):105-9.
8. Bailey RR. The relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis-reflux nephropathy. Clin Nephrol 1973;1:132e41.
9. Cohen SJ. The Cohen reimplantation technique. Birth Defects Orig Artic Ser. 1977;13:391e5.
10. Tekgu¨l, S, Dogan H, Hoebeke P, Radmayr C, Kocvara R, et al. EAU guidelines on paediatric urology. https://uroweb.org/guideline/paediatric-urology/#3_13.
11. Mure PY, Mouriquand PD. Surgical atlas the Cohen procedure. BJU Int. 2004; 94: 679 e98.
12. Lusuardi L, Hruby S, Jeschke S, Zimmermann R, Sieberer M, Janetschek G. A new technique for retrograde flexible ureteroscopy after Cohen cross-trigonal ureteric reimplantation. Urol Int. 2011;87:260e2.
13. Kim KH, Lee YS, Im YJ, Lee CN, Han SW. A modified technique for ureteric reimplantation: intravesical detrusorrhaphy. J Pediatr Surg. 2013;48:1813e8.
14. Haid B, Strasser C, Becker T, Koen M, Berger C, Roesch J, Stuehmeier J et al. Evaluation of Mathisen's technique for ureteric reimplantation in children with primary vesicoureteric reflux. Journal of pediatric urology. 2016 Dec 1;12(6):393-e1.
15. Chaudhary S, Lee M, Andrews HO, Buchholz NN. Ureterolithiasis after Cohen re-implantationdcase report. BMC Urol. 2004;4:2.
16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240: 205e13.
17. Paquin AJ. Ureterovesical anastomosis: the description and evaluation of a technique. J Urol. 1959;82:573e83.
2. Lau G, Anderson R, Cartwright P, Wallis MC, Schaeffer A, Oottamasathien S, Snow B. Unilateral open extravesical ureteric reimplanation with contralateral dextronomer/hyaluronic acid injection performed as an outpatient therapy. Journal of pediatric urology. 2018 Dec 1;14(6):566-e1.
3. Jayanthi V, Patel A. Vesicoscopic ureteric reimplantation: a minimally invasive technique for the definitive repair of vesicoureteric reflux. Adv Urol. 2008;2008:973616.
4. Chertin B, Kocherov S, Chertin L, Natsheh A, Farkas A, Shenfeld OZ, Halachmi S. Endoscopic bulking materials for the treatment of vesicoureteric reflux: a review of our 20 years of experience and review of the literature. Adv Urol. 2011;2011: 309626.
5. Callewaert P.R.H ‘What is new in surgical treatment of vesicoureteric reflux?’ Eur J Pediatr. 2007 Aug; 166(8): 763–8.
6. Chung JM, Park CS, Lee SD. Postoperative ureteric obstruction after endoscopic treatment for vesicoureteric reflux. Korean journal of urology. 2015 Jul 1;56(7):533-9.
7. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. Pediatric radiology. 1985 Feb 1;15(2):105-9.
8. Bailey RR. The relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis-reflux nephropathy. Clin Nephrol 1973;1:132e41.
9. Cohen SJ. The Cohen reimplantation technique. Birth Defects Orig Artic Ser. 1977;13:391e5.
10. Tekgu¨l, S, Dogan H, Hoebeke P, Radmayr C, Kocvara R, et al. EAU guidelines on paediatric urology. https://uroweb.org/guideline/paediatric-urology/#3_13.
11. Mure PY, Mouriquand PD. Surgical atlas the Cohen procedure. BJU Int. 2004; 94: 679 e98.
12. Lusuardi L, Hruby S, Jeschke S, Zimmermann R, Sieberer M, Janetschek G. A new technique for retrograde flexible ureteroscopy after Cohen cross-trigonal ureteric reimplantation. Urol Int. 2011;87:260e2.
13. Kim KH, Lee YS, Im YJ, Lee CN, Han SW. A modified technique for ureteric reimplantation: intravesical detrusorrhaphy. J Pediatr Surg. 2013;48:1813e8.
14. Haid B, Strasser C, Becker T, Koen M, Berger C, Roesch J, Stuehmeier J et al. Evaluation of Mathisen's technique for ureteric reimplantation in children with primary vesicoureteric reflux. Journal of pediatric urology. 2016 Dec 1;12(6):393-e1.
15. Chaudhary S, Lee M, Andrews HO, Buchholz NN. Ureterolithiasis after Cohen re-implantationdcase report. BMC Urol. 2004;4:2.
16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240: 205e13.
17. Paquin AJ. Ureterovesical anastomosis: the description and evaluation of a technique. J Urol. 1959;82:573e83.
Published
2022-12-27
How to Cite
ADHIKARI, Suman Bikram et al.
Outcome analysis of Cohen’s cross trigonal ureteric reimplantation in paediatric age group.
J Soc Surg Nep, [S.l.], v. 25, n. 2, p. 35-39, dec. 2022.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=501>. Date accessed: 24 oct. 2024.
Section
Original Article
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright and Open Access Policy
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
JSSN applies the Creative Commons Attribution (CC BY) license to all works we publish. Under the CC BY license, authors retain ownership of the copyright for their article, but authors allow anyone to download, reuse, reprint, distribute, and/or copy articles in JSSN, so long as the original authors and source are cited. No permission is required from the authors or the publishers.
Article by JSSN is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.jssn.org.np/index.php?journal=jssn.
