Question

Types of ureteric reimplantation.

Hint:

The modified Lich-Gregoir procedure is the most commonly used technique for ureteric reimplantation and is particularly effective in preventing reflux in pediatric patients.

Answer 1

Ureteric reimplantation is a surgical procedure used to correct abnormalities of the ureter, such as reflux, obstruction, or injury. There are different types of ureteric reimplantation, depending on the indication and the technique used.
Step 1: Types of Ureteric Reimplantation:
1. Modified Lich-Gregoir Procedure: The most common technique for reimplanting the ureter. It involves creating a submucosal tunnel through which the ureter is implanted into the bladder, providing a valve mechanism to prevent reflux. This technique is often used for vesicoureteral reflux (VUR).
2. Anderson-Hynes Procedure: This technique involves creating an extravesical tunnel and reimplanting the ureter at a more lateral position in the bladder. It is more commonly used in pediatric patients and for cases involving severe VUR or large ureteral anomalies.
3. Intravesical Reimplantation: This is a simpler technique where the ureter is directly reimplanted into the bladder. It is less commonly used but may be considered in specific cases of obstruction or distal ureteral injury.
4. Ureteral Mobilization with Reimplantation: In cases where the ureter is tortuous or shortened, mobilization is performed to allow for proper reimplantation. This technique is used in both congenital and acquired conditions.
Step 2: Indications for Ureteric Reimplantation:
1. Vesicoureteral Reflux (VUR): A common indication for reimplantation, where the backflow of urine from the bladder into the ureter and kidneys occurs, leading to kidney damage.
2. Ureteral Obstruction: Reimplantation may be necessary when there is an obstruction in the ureter, causing hydronephrosis and impaired renal function.
3. Ureteral Injury: After trauma or surgical complications, reimplantation can help restore the integrity of the ureter.