289 / 330
289
19–22 APRIL, 2017, BARCELONA, SPAIN
RESULTS
There was no intraoperative or postoperative complication and surgical time was 19 ± 9 minutes.
All patients were discharged at 24 postoperative hours. Ureterohydronephrosis disappeared in all
the children and they stay asymptomatic after 24 ± 28.5 months of follow-up. There was no case of
secondary vesicoureteral reflux and renal scan remained unchanged after treatment.
CONCLUSIONS
Treatment of orthotopic ureterocele by high-pressure balloon dilatation of the meatus is a fast, safe
and successful surgical technique. We did not find any case of secondary vesicoureteral reflux and
no subsequent procedures were needed. We believe this technique may offer significant benefits
over transurethral puncture in such patients.
VS-14 (VS without presentation)
MODIFIED SHANFIELD ANASTOMOSIS
FOR LAPAROSCOPIC EXTRAVESICAL REIMPLANT
OF URETER: A VIDEO CASE REPORT
Anu PAUL, Navroop JOHAL and Abraham CHERIAN
Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Extravesical reimplantation of the ureter is a well established technique. When performed laparo-
scopically, the most challenging step is creating the water-tight ureterovesical (UV) anastomosis
which requires advanced laparoscopic suturing skills. We demonstrate laparoscopic extravesical
reimplant of the ureter with a modified Shanfield anastomosis simplifying the process. The UV
anastomosis described is a modification of the Shanfield anastomosis first described in 1972.
MATERIAL AND METHODS
A vertical extramucosal detruserotomy is created to provide the submucosal tunnel for the ureter.
The bladder is entered at the inferior end of the prolapsed mucosa.
The ureter is spatulated for about 5 mm and prolapsed into the bladder. The UV anastomosis is
made between the seromuscular layer of the bladder wall and the serosa of the ureter, 1cm proximal
to the end of the ureter. This ensures that the end of the ureter is well prolapsed into the bladder.
Usually 3 sutures suffice to fix and stabilise the anastomosis before closing the extramucosal tunnel.
RESULTS
Our patient, a three year old, who underwent undiversion of an end ureterostomy with laparoscopic
reimplant in the method described above, made a rapid recovery and remains infection free.
CONCLUSIONS
The modified Shanfield UV anastomosis , when utilised for laparoscopic extravesical reimplant of
the ureter, simplifies the procedure and potentially shortens operating time.