Objective:To summarize the experience of the modified Politano-Leadbetter procedure under the pneumatic bladder for the treatment of distal ureteral stenosis,and improve the level of diagnosis and treatment.Methods:A retrospective analysis was conducted on the clinical data of 15 children with ureterobladder junction stenosis admitted to the pediatric surgery department of Xiamen Maternal and Child Health Hospital from January 2020 to January 2022.All patients were treated with modified pneumatic bladder laparoscopic Politano-Leadbetter procedure including 12 boys and 3 girls;The average age was 4.5 years from 6 months to 8 years old.Among them,there were 5 cases on the right side,9 cases on the left side,and 1 case on both sides.Operation method:establish the pneumatic bladder routinely,place laparoscope and operation instruments under cystoscope,free the ureter in the bladder,and apply the three-point one line principle of urethral orifice ureteral opening new ureteral hole to accurately find the ureter outside the bladder.Free the lower segment of the ureter,suture the traction line at the end of the ureter,relocate the already free ureter into the bladder from the new ureteral hiatus,establish a submucosal tunnel,embed the distal ureter into the submucosal tunnel,remove the narrow and partially dilated u-reter,suture the urethral opening,and then insert a double J tube to complete the Leadbetter ureteral reimplanta-tion surgery.Urine routine was regularly reviewed after the operation,and urinary color ultrasound and voiding cystourethrography(VCUG)were examined to evaluate indicators such as hydronephrosis,ureteral dilation or stenosis,presence of ureteral reflux,and renal function parameters.Results:All 15 cases underwent Politano-Leadbetter surgery under the pneumatic bladder without conversion to open surgery.The unilateral surgery time was 81 to 103 minutes,with an average of(91.0±16.5)minutes.The bilateral surgery time ranged from 135 to 165 minutes,with an average of(149.0±15.4)minutes.There was almost no significant bleeding during the operation.Af-ter 8 days of surgery,the urinary catheter was removed,and all patients did not experience difficulty in urinating,incision infection,or incision dehiscence.The hospital stay was 8-15 days.All 15 cases were followed up for 12-24 months,and there were no complications such as urinary leakage,incision infection,urinary tract infection,blad-der ureteral reflux,or obstruction of the ureter bladder junction.After 12 months of surgery,the value of the an-terior and posterior diameter of the renal pelvis measured by color Doppler ultrasound was(0.95±0.35)cm com-pared to preoperative(2.68±0.75)cm,and the maximum diameter of the ureter was(0.75±0.21)cm com-pared to preoperative(2.85±0.65)cm.The difference was statistically significant(P＜0.01).Conclusion:The modified Politano-Leadbetter procedure under the pneumatic bladder has become a mature surgical method for treating pediatric distal ureteral stenosis,and is easy to learn.It is safe and effective for its high success rate,fast postoperative recovery,and preservation of the original opening position and anatomical direction of the ureter.
politano leadbetter techniquelaparoscopestenosis of the bladder ureteral junctionureteral re-plantation
NETL
NSTL
万方数据
