Comparison Of Ureteral Nipple And Submucosal Tunnel Vesico-ureteral Reimplantation For Ureteral End Stricture

Objective: This study aims to compare all the clinical data from patients of ureteralnipple vesico-ureteral reimplantation and submucosal tunnel vesico-ureteralreimplantation in our hospital, to evaluate operation effect and clinical value ofureteral nipple vesico-ureteral reimplantation, thus to provide a scientific basis for thepopularization and promotion of operation mode.Methods: Retrospective analysis of the clinical data of ureteral end stricture andhydronephrosis in56cases from January2008to June2012in Department ofUrology of Affiliated Hosptial of Qinghai University.In all of these cases, ureteralnipple vesico-ureteral reimplantation in24cases (group A), submucosal tunnelureteral reimplantation in32cases (group B). Compare whether there is obviousdifference in age, gender, preoperative degree of hydronephrosis, operation time(min),bleeding loss(ml), postoperative anti-vesicoureteral reflux rate, postoperativehydronephrosis remission rate, incidence rate of postoperative complications betweentwo groups.Results: Ureteral nipple vesico-ureteral reimplantation group(group A) in24cases,the operations were all successful.age:38.2±12.3years(10~59years); gender(M/F):8/16；preoperative degree of hydronephrosis(S/M):15/9；the operation time:90.3±13.5min(78~124min)； bleeding loss during operation:127.6±31.4ml(100~210ml)；after operation follow-up for6~48months, concurrent urinary Bultrasound, CT, IVP, the voiding phase cystography examination,16cases ofhydronephrosis were disappeared,7cases of hydronephrosis were reduced apparently,postoperative hydronephrosis remission rate:95.8%;2cases of ureteral reflux,postoperative anti-vesicoureteral reflux rate:91.6%;1case appeared to narrow againand was cured after transluminal ballon dilatation,1case of postoperative urinaryleakage, disappeared after operation2weeks after the closed negative pressure drainage tube. incidence rate of postoperative complications:12.5%.Submucosal tunnel operation group (group B) in32cases, all the operationswere successful. age:36.4±10.6years(13~62years); gender(M/F):13/19; preoperativedegree of hydronephrosis(S/M):22/10;the operation time:122.4±15.7min(90~150min); bleeding loss during operation:212.6±42.5ml(180~300ml);afteroperation follow-up for6~48months, concurrent urinary B ultrasound, CT, IVP, thevoiding phase cystography examination,18cases of hydronephrosis were disappearedcompletely,12cases of hydronephrosis were reduced apparently, postoperativehydronephrosis remission rate:93.8%;1cases of ureteral reflux, postoperativeanti-vesicoureteral reflux rate:96.8%;2cases appeared to narrow again, were curedafter the second operation.2cases of urinary leakage, disappeared after operation2weeks after the closed negative pressure drainage tube, incidence rate of postoperativecomplications:15.6%.Compared the data of ureteral nipple group and submucosal tunnel group, therewas no significant difference between two groups in age, gender, preoperative degreeof hydronephrosis, postoperative hydronephrosis remission rate, postoperativeanti-vesicoureteral reflux rate, incidence rate of postoperative complications (p＞0.05); at operation timeand blood loss during operation, ureteral nipple vesico-ureteralreimplantation group was better than submucosal tunnel vesico-ureteralreimplantation group(p＜0.05).Conclusion: Compare with submucosal tunnel vesico-ureteral reimplantation,ureteral nipple vesico-ureteral reimplantation has the advantages of simple operation,short operation time, bleeding volume less and so on, and it almost has the very effectas the bladder submucosal tunnel method in hydronephrosis remission rate,anti-vesicoureteral reflux rate and postoperative complications, it is easily mastered,suitable for clinical application.