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PAEDIATRIC UROLOGY

7.4.4 Open surgery

Various techniques for reflux correction have been described (e.g. Lich-Gregoir, Politano-Leadbetter, Cohen, Psoas-Hitch), the principle being to lengthen the intramural part of the ureter by submucosal embedding of the ureter. A high success rate of over 95%, with only a small rate of complications, is shared by all surgical procedures.

As a rule, prior to extravesical procedures an endoscopy should be performed, whereas the ureteral orifices can be directly visualized with intravesical operations. Other important technical details are an absolutely tension free ureteral anastomosis, as well as meticulous preservation of the blood supply of the distal ureter. In addition, a sufficient length and width of the tunnel is mandatory.

In case of a bilateral reflux the Lich-Gregoir as well as the Psoas-Hitch procedure should be performed in two stages to prevent bladder dysfunction.