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내시경 수술 이후 재발한 Hutch 게실이 동반된 방광요관역류의 교정 시 공기방광 접근법의 효용성
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¹고려대학교 안산병원 비뇨의학교실
²고려대학교 구로병원 비뇨의학교실 |
| 전병조¹, 이영훈¹, 이동현², 안순태², 문두건², 배재현¹ |
Objective: To report our initial experience with pneumovesical approach for Politano-Leadbetter ureteral reimplantation with Hutch diverticulectomy in the patient who has undergone endoscopic injection for vesicoureteral reflux(VUR).
Case presentation: A 5-year-old boy visited the emergency center for fever. Right acute pyelonephritis was diagnosed and grade III VUR on the right side with Hutch diverticulum was confirmed on the voiding cystourethrogram(VCUG). Although endoscopic injection was performed, urinary tract infection recurred after 6 months and right hydronephrosis was aggravated. Thus, pneumovesicoscopic ureteric reimplantation with diverticulectomy was scheduled.
The three 5 mm ports were introduced through the bladder wall under cystoscopic vision. A 5-0 monofilament traction suture was used and ureteral dissection was carried out. After the ureteral mobilization, the location of the new hiatus was selected in a straight line superior to the original orifice. Dissection of the submucosal tunnel was started from the new hiatus and advanced to the original hiatus and the ureter was gently drawn passed through the tunnel. And then, The diverticulum was inversed and then dissected. After diverticulum was removed, the bladder wall was sutured with interrupted 4-0 vicryl sutures. Finally, ureterovesical anastomosis was performed with intracorporeal suturing using 5-0 monofilament sutures. The patient had a quick recovery without any post-operative complications. The VUR was disappeared on postoperative VCUG.
Conclusion: In patient who had undergone endoscopic injection, pneumo-vesicoscopic ureteral reimplantation with diverticulectomy was effective and feasible.
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keywords : Vesico-Ureteral Reflux, Diverticulum, Pneumovesicum |
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