Paramedian extraperitoneal approach for combined nephrectomy and augmentation ureterocystoplasty in children with neurovesical dysfunction.

Abstract

We describe and evaluate our approach to combined nephrectomy and augmentation ureterocystoplasty using a single paramedian extraperitoneal incision. Three patients with neurogenic bladders (2 posterior urethral valves and 1 myelodysplasia) underwent nephrectomy and augmentation ureterocystoplasty. The mean age of the patients was 4.6+/-1.5 years. The indications for the procedure included control of urinary incontinence or preservation and stabilization of renal function. The integrity of the peritoneal cavity was easily preserved throughout the procedure using a paramedian incision. No complications were encountered in these patients. Early postoperative resumption of normal diet and activity was noted in all patients. The paramedian extraperitoneal approach through a single incision provides the advantages seen with other extraperitoneal techniques combining two incisions. The single paramedian incision has the potential to save on operative time and obviates the need to change the patient's position on the operating table while under anesthesia. Furthermore, the paramedian extraperitoneal approach provides the reconstructive surgeon with the chance to convert the procedure into a transperitoneal technique to incorporate bowel segments in order to complement ureterocystoplasty.