Primary and Reoperative Cecoureterocele: Definitive Reconstruction with Pubic Symphysis Splitting
Joseph Borer, MD1, Marie-Therese Valovska, MD2, Hsin-Hsaio Scott Wang, MD, MPH, MBAn1
1Boston Children's Hospital, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA
PURPOSE: Cecoureterocele may cause severe disruption of lower urinary tract (LUT) anatomy and function. With videography, we detail technical aspects of definitive reconstruction including pubic symphysis splitting (PSS) to optimize exposure.
MATERIAL AND METHODS: We reviewed patients with cecoureterocele treated with PSS at our institution since 2011. History, imaging, and evaluation (RUS, VCUG, DMSA, UDS) prior to definitive repair were reviewed. PSS facilitated definitive LUT repair including cecoureterocele excision, bladder floor repair, bladder neck reconstruction (BNR) and urethroplasty. Extensive scar resection, anatomical rehabilitation, and meticulous attention to preservation of muscularis and mucosal tissue facilitated successful reconstruction.
RESULTS: We identified 3 girls with cecoureterocele treated with PSS at definitive repair. One patient presented at our institution with prenatal hydronephrosis and underwent primary repair. Two patients had 3 and 5 surgeries prior to referral including partial nephrectomy, excision of ureterocele, “closure” of ureterocele, bilateral ureteral reimplant, reoperation reimplant, bladder neck Deflux injection, BNR and DVIU. One patient each had either continuous or overflow urinary incontinence at referral. All patients had an associated duplex system and VUR. Age at definitive repair was 0.7, 10, and 15 years. Following definitive reconstruction, average follow-up was 4.8 years (range 0.3-8 years), and both patients with incontinence had improvement by history and VCUG. All were voiding, free of obstruction, and ultimately free of VUR.
CONCLUSIONS: Patients with cecoureterocele may require extensive LUT reconstruction, especially those with severe incontinence and/or obstruction following initial repair. Pubic symphysis splitting provides optimal exposure for complete repair and normal bladder function in these patients.
Back to 2023 Abstracts