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19–22 APRIL, 2017, BARCELONA, SPAIN
17:52–17:57
SP3-5 (VP)
TRANSURETHRAL NEO-ORIFICE (TUNO): A MINIMALLY
INVASIVE TREATMENT FOR ECTOPIC OBSTRUCTIVE
MEGAURETER
Alberto PARENTE
1
, Ruben ORTIZ
2
, Laura BURGOS
2
and Jose Maria ANGULO
2
1) GREGORIO MARAÑÓN UNIVERSITY HOSPITAL, PEDIATRIC SURGERY, Madrid, SPAIN - 2) Gregorio Marañon
University Hospital, Pediatric Urology, Madrid, SPAIN
PURPOSE
To present the creation of a transurethral neo-orifice (TUNO) near the trigone as an initial approach
in duplicated ectopic megaureters with preserved moiety function to avoid external urinary diversion.
MATERIAL AND METHODS
We have treated with these technique 7 infants. They presented unilateral duplicated system and
ectopic obstructive upper ureter. All patients were symptomatic with at least two urinary infections
despite nocturnal antibiotic prophylaxis and increasing hydronephrosis.
In all cases the urethrocystoscopy failed to show the meatus of the ectopic ureter. During the cystos-
copy the dilated distal end of the ureter was identified with ultrasound. Under ultrasound scan and
direct cystoscopic vision the retrovesical ectopic ureter was punctured transvesically. The puncture
was done with a 4Fr needle and contrast was instilled in the ectopic ureter to obtein retrograde
pyelogram. Through the puncture needle a 0,014´´guidewire was inserted into the upper moiety.
The punctured site was then dilated with a high-pressure balloon and the neo-meatus edge was
coagulated with monopolar electrocautery to achieve cohesion.
RESULTS
The mean operative time was 57 ± 11 minutes. The mean age at treatment was 2.8 ± 1.9 months.
There were not perioperative or postoperative complications. Urinary tract infections disappeared
in all cases after the procedure. The assessment done 6 months postoperatively demonstrated
a significant decrease in the grade of the hydronephrosis in all cases.
CONCLUSIONS
Creation of TUNO is a minimally invasive technique successful as the initial management of ec-
topic ureter. It avoids urinary tract infections, decrease the dilatation and preserve the parenchyma
function.
17:57–18:00
Discussion