Vesicoscopic supra trigonal ureteric reimplantation and detrusorraphy (STURDY) for vesicoureteric reflux in children with duplex systems.

Abstract

Introduction/aims: We hereby report a novel vesicoscopic supra trigonal ureteric reimplantation detrusorraphy (STURDY) technique for unilateral duplex systems with vesicoureteric reflux (VUR).

Methods: A 3-year-old boy and a 1-year-old girl with recurrent urinary tract infections (UTIs) and left duplex VUR/ureterocele underwent vesicoscopic STURDY.

Technique: After establishing pneumovesicum, a vertical incision was made cranially along the ureter for 2-3 cm incising both the mucosa and detrusor, preserving the vas deferens. Duplex ureters were carefully dissected and brought intravesically, and a detrusorraphy was performed underneath. The mucosa was closed over the ureters sandwiching the ureter between detrusorraphy and mucosal closure. In both cases double-J-stents were kept for 6-weeks.

Results: Both patients had uneventful postoperative period. Follow-up ultrasound showed significant improvement in hydroureteronephrosis. At one-year follow-up there was no reflux and function was preserved.

Discussion: There is limited literature on transvesicoscopic common-sheath ureteric reimplantation in duplication anomalies. Cohen's technique is commonly preferred due to its simplicity and high success rates, but it aligns all three ureteric orifices on one side, hindering future upper tract access.

Conclusion: The novel vesicoscopic STURDY technique reported is safe, effective, preserves vascularity of both ureters and allows future ureterorenoscopy. Further studies with long-term follow-up are warranted.