Pediatric, Perinatal and Diagnostic Pathology

Biography

Biography: Majed Sarayreh

Abstract

Historically the Cohen technique has been considered the “gold” standard in open surgical management of VUR. This technique has the inherent end result of placing the uretric orifice across the midline of the trigon and theoretically making future access to the uretric orifice possibly more difficult than if they remained lateralized. The Glenn-Anderson technique does not require contra lateral placement of the uretric orifice thus likely not complicating future UO access.  We compared both techniques in pediatric age group at two separate institutes to assess the feasibility and short term outcomes. Methodology: Between April 2014 and April 2015, 90 consecutive cases of  ureteral reimplantation performed for VUR were retrospectively analyzed  in two different hospitals. Surgical complications, length of stay and short term outcomes were evaluated in an attempt to assess the equivalence or superiority of either procedure.  Forty five cases ( 75 ureters) group (A) from Queen Rania Children Hospital, King Hussein Medical Center, Amman-Jordan, managed by Cohen procedure.  Forty five cases, (65 ureters) ,group (B) from Rocky Mountain Children Hospital at Presbyterian St. Luke's Medical Center, Colorado.  All patient had single system ureter without complex anatomy such as ureterocele, duplex collecting systems, or megaureters. Results: Surgical indication in all patients was VUR and VUJ obstruction. All patients in group A were discharged at day 4 to 5 post-operatively while patients in group B were discharged at second day post-op. Patients age was ranged between 8 months and 10 years while body weight ranged from 9 to 38 Kilograms. All patients in group A had local anesthetic incisional wound infiltration compared to group B whom received caudal block and bladder neck and trigonal  local anesthesia in addition to incisional block. Five patients in group A developed urine retention while none in B. Four patients in group A had no resolution but downgrading of their VUR. No patient to date has required further surgical intervention. Conclusion: Glenn-Anderson procedure is a feasible and equivalent technique to Cohen cross -trigonal -ureteral reimplantation. Glenn-Anderson technique theoretically as a result of a more orthotropic uretric orifice placement  should allow for easier ureteral access in patients that developed urolithiasis requiring retrograde ureteral access.  Length of stay as a measure of postoperative convalescence was superior in the GA technique with all patients being discharged the day after surgery. Perhaps the adjunct local wound infiltration into the bladder neck and trigone played a major role in the ability for earlier discharge?  It is not unreasonable to consider this technique as equivalent and potentially superior to others for these reasons. Further prospective study looking at postoperative pain measures and longterm surgical outcomes as well as latent need of additional ureteral access procedure will be necessary to confirm our initial impressions.