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| Name | Laparoscopic Extravesical Reimplantation in a child with Primary Obstructive Megaureter |
| Video Uploader | Video From Dr Shandip_pedsurg_peduro |
| Upload Date | This Video Uploaded At 14-04-2021 14:35:12 |
| Video Discription | The Primary Megaureters are being diagnosed with increased regularity in antenatal scans. As per British Association of Paediatric Urologists (BAPU) guidelines, most of them are managed by initial conservative means with only 10-15% of children needing surgical intervention. They suggested that the indicators for surgical intervention, should be an initial DRF on MAG3 less than 40%, especially when associated with massive hydroureteronephrosis, and failure of conservative management (breakthrough febrile UTIs, pain, worsening dilatation, or deteriorating DRF).In Indicated children over 1 year of age, the procedure of choice followed by the majority of surgeons is ureteric reimplantation with or without ureteral tapering. Primary obstructive Megaureter management in a child less than one year of age is controversial and includes conservative to operative ones for certain indications. British Association of Paediatric Urologists (BAPU) advises antibiotic prophylaxis for the first 6- 12 months of life in the presence of hydroureteronephrosis. Problem arises in infants with failure of conservative management or in asymptomatic patient, with findings suggestive of Primary Obstructive Megaureter. The BAPU considers the presence of an initial DRF below 40%, or a drop in DRF of 5% on serial scans, and/or increasing dilatation on serial ultrasound scans, to be suggestive of obstruction (Primary Obstructive Megaureter). The treatment options in these infants needing intervention includes ureteric reimplantation with tapering, Cutaneous ureterostomy, Refluxing Reimplantation, Temporary DJ Stenting, (if stenting possible ) and Endoscopic balloon dilatation. Ureteric Reimplantation is not favored by majority in children less than one year of age. We here describe a child who had obstructive megaureter who was managed initially by cutaneous ureterostomy followed by Laparoscopic Ureteric reimplantation. The diversion lead to decrease in size of megaureter, making reimplantation easy. She also had Anovestibular fistula, which was managed by single surgery i.e. Anterior sagittal anorectoplasty ( ASARP), which was done at time of cutaneous ureterostomy. |
| Category | Education |
| Tags | Education Download MP4 | Education Download MP3 | Education Download MP4 360p | Education Download MP4 480p | Education Download MP4 720p | Education Download MP4 1080p |
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