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PubMed1985

The role of dysfunctional voiding in failure or complication of ureteral reimplantation for primary reflux.

Detrusor and/or urethral sphincter dysfunction is associated with increased failure or complication of ureteral reimplantation. A group of 400 children who underwent ureteral reimplantation was reviewed and the failure rate was determined. Those patients in the primary reflux category who failed were reviewed in detail for voiding dysfunction. Excluding technical error or ureteral dysfunction, the greatest risk for failure or complication of ureteral reimplantation seems to be related to detrusor and/or urethral sphincter dysfunction. Voluntary detrusor-sphincter discoordination seems particularly prevalent in this high risk group. The findings are discussed in relation to the over-all management of these patients.

Child↗
PubMed1981

Epithelial lesions of bladder mucosa following ureteral reimplantation.

We report on 3 children who underwent ureteral reimplantation. Postoperatively, each patient had persistent, irritative, lower tract symptoms and continuous or recurring urinary infections, with or without gross hematuria. Because of these symptoms cystoscopy was done in 2 children and the third child under went repeat ureteral reimplantation because of persistent vesicoureteral reflux. At operation single or multiple hyperplastic, sessile lesions of the urothelium, not evident at the time of initial ureteral reimplantation, were discovered in each child. Histologically, these lesions showed proliferative and metaplastic glandular epithelial changes. Treatment consisted of transurethral fulguration and long-term antimicrobial medication plus partial cystectomy and topical intravesical chemotherapy for recurrent lesions in 1 child. The etiology of these epithelial lesions, although uncertain, is believed to be a response to long-standing inflammation.

Adolescent↗
PubMed1980

Routine use of the psoas hitch in ureteral reimplantation.

Previously, the psoas hitch had been advocated only for difficult cases of ureteral implantation, especially when there had been inadequate ureteral length. However, during the last 10 years the paoas hitch in association with a modified Paquin technique has been used routinely at this institution for ureteral reimplantation. The technique has been used in all unilateral cases and in most bilateral reimplants. Results have been excellent. The psoas hitch allows for a long submucosal tunnel, with a fixed relationship between the ureter and posterolateral bladder wall. Intermittent hydronephrosis is not seen with this method of reimplantation and there have been no voiding disturbances.

Humans↗
PubMed1979

Revision of ureteral reimplantation by the transverse advancement technique.

Antireflux ureteral reimplantation may be performed by a variety of techniques with consistently satisfactory results. Complications, such as persistent reflux and postoperative ureterovesical obstruction, may be encountered occasionally and, when significant, they will necessitate a revision operation. Herein 6 cases are described of failed ureteral reimplantation, which were revised successfully by performing a transverse advancement ureteral reimplantation.

Child↗
PubMed1978

Ureteral reimplantation by the transverse advancement technique.

When the transverse advancement technique of ureteral reimplantation is used the submucosal tunnel is made transversely across the base of the bladder. This method was used for reimplantation of 131 ureters in 92 children. The results indicate that the transverse advancement technique is adaptable to virtually any situation requiring ureteral reimplantation and is a simple, safe and reliable procedure for prevention of reflux.

Adolescent↗
PubMed1977

Experimental reimplantation utilizing microvascular anastomosis in animals.

The use of the operating microscope and special microsurgical instruments make it possible to achieve successful anastomosis of blood vessels of less than 1 mm in diameter. Microvascular surgery offers newer possibilities in the transplantation of dermisfat grafts, and has led to an unusually high degree of success in the reimplantation of tissues. This paper describes a technique for microvascular anastomosis in animal experiment, using as a model the reimplantation of a completely amputated rabbit ear. In 10 amputated rabbit ears, the central auricular artery with a diameter of 0.5 mm and the two marginal auricular veins with diameter of 0.5-1.0 mm were microsurgically anastomosed. Of the 10 reimplanted ears, 8 survived. The postoperative angiogram showed an unrestricted patency of all the vessels.

Animals↗
PubMed1991

[Digital reimplantations and revascularizations. Factors of preservation. 183 fingers].

The causes of vascular failures of a series of 183 injured fingers treated by microsurgery (80 reimplantations, 103 revascularisations) were investigated. This consecutive series was characterised by the fact that the operation was performed even in the presence of classical factors of poor prognosis: patients over the age of 40 years (27%), smoking (51%), crush injury or avulsion (32%), ischaemia time longer than 7 hours (46%). The overall intraoperative and postoperative failure rate was 49% (69% in reimplantations and 31% in revascularisations). Preoperative factors (age, smoking, mechanism, ischaemia time) were not sufficiently important to constitute contraindications to vascular microsurgery. Only storage of the segment in contact with iced water made failure almost certain. Suture of 2 arteries and one or several veins (in the absence of a skin bridge) improved the prognosis. The postoperative use of subcutaneous heparin in reimplantations significantly decreased the failure rate from 77% to 55%. Postoperative surveillance is essential to rapidly detect the arterial or venous mechanism responsible for vascular disorders and to decide appropriate emergency treatment. Arterial ischaemia warrants revision of the sutures with a success rate of about one in two. Disturbances of the venous drainage should initially be treated medically (2/3 of preservation after drainage by leeches), but, when this is not effective, surgical revision salvages one third of failures. Emergency microsurgery units must therefore have access to a specialised postoperative surveillance unit.

Adolescent↗
PubMed2000

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

BACKGROUND/AIMS: Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. METHOD: In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). RESULTS: Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. CONCLUSIONS: From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Adolescent↗
PubMed2003

The long-term outcome of bilateral Cohen ureteric reimplantation under a common submucosal tunnel.

OBJECTIVE: To analyse the results of bilateral Cohen reimplantation under a common submucosal tunnel, over an 18-year period. PATIENTS AND METHODS: We retrospectively examined 102 children (35 boys and 67 girls, median age 5.5 years, range 0.5-13.5) who underwent bilateral antireflux ureteric reimplantation from 1983 to 2000 with a modified Cohen technique, re-implanting both ureters under a common submucosal tunnel in the mid-trigonal area, to treat primary vesico-ureteric reflux (VUR, 99 patients) or obstructive megaureter (three). The mean (range) follow-up was 10.6 (2-18) years. RESULTS: The operation was successful in 198 of 204 (97%) ureters. One patient had vesico-ureteric stenosis in one ureter and was re-operated successfully. In two ureters in two different patients there was transient stasis after surgery caused by oedema within the tunnel, which gradually resolved. Two ureters in two other patients had reflux after surgery, which resolved spontaneously after 12 and 24 months, respectively. A 6-month old baby had anuria after surgery because of acute compression of both ureters within a narrow tunnel; this patient was re-operated, the tunnel widened and the obstruction resolved. None of 82 patients who had reached school age by the time of their last follow-up showed signs of voiding dysfunction. CONCLUSIONS: The modified bilateral Cohen reimplantation with both ureters under a common submucosal tunnel offers very good long-term results in curing VUR or obstructive megaureter. Crossing one ureter upon the other within the tunnel does not predispose to long-term obstruction. From these results we recommend it as a reliable technique for surgically treating bilateral VUR or obstructive megaureter.

Adolescent↗
PubMed2001

Staged reimplantation of total knee arthroplasty after Candida infection.

Prosthetic joint infection with Candida is uncommon. Only 28 cases have been reported in the English literature. Successful reimplantation after eradication of Candida infection has been reported in 3 hip joints and only 1 knee. We present the case of a 68-year-old woman with chronic Candida parapsilosis infection of a prosthetic knee joint. Removal of the prosthesis, thorough débridement, and antifungal therapy treated the infection successfully. Antifungal therapy included 6 weeks of parenteral administration of fluconazole followed by 4 weeks of oral fluconazole. The involved knee joint was reimplanted 3 months after initial treatment. The prosthetic joint was pain free and functioned satisfactorily during the ensuing 4 years. No recurrence of infection was noted. The principle in treating Candida prosthetic infection generally has been the same as that of bacterial prosthetic infection. In chronic cases, removal of implants, thorough débridement, and effective antifungal therapy are mandatory for the eradication of infection. Reimplantation of the prosthesis can be performed successfully in a staged surgical procedure with the interval between the 2 stages shortened to 3 months.

Aged↗
PubMed2002

Mid-term results of aortic valve preservation: remodelling vs. reimplantation.

OBJECTIVE: Valve-preserving root replacement has become an accepted alternative to composite replacement both in dissection and in aneurysmal disease. We retrospectively analysed 5-year results comparing root remodelling and reimplantation procedures. METHODS: From October 1995 to January 2001, 119 patients underwent either root remodelling (group A; n = 98; age: 61 +/- 14 years) or valve reimplantation within a vascular graft (group B; n = 21; age: 47 +/- 17 years). In group A, 26 patients were operated for aortic dissection type A and 72 for aortic valve regurgitation and aneurysmal disease. In group B, 8 patients were operated for aortic dissection type A, 13 for aortic valve regurgitation and aneurysm. Concomitant arch surgery was performed in 65 patients (group A: 57; group B: 8). RESULTS: Time on cardiopulmonary bypass was 121 +/- 30 min in group A, 143 +/- 24 min in group B, and aortic cross-clamp time was 87 +/- 19 min in group A and 113 +/- 24 min in group B. Average duration was therefore longer in group B (p = n.s.) Hospital mortality was 3.1 % in group A and 0 % in group B. Following elective procedures, hospital mortality was 1.1 % in group A. Freedom from aortic regurgitation over grade 2 at 4 years was 86 % in group A and 94.7 % in group B. At 4 years, freedom from proximal reoperation was 97.8 % in group A and 100 % in group B. There was no deterioration of valve function or need for reoperation observed after 1 year in either group. CONCLUSION: Five-year results are comparable and encouraging for remodelling and reimplantation procedures. If the initial valve function and geometry is adequate, the chance of secondary failure beyond the first year is minimal.

Adult↗
PubMed2004

Laparoscopic extravesical reimplantation for postpubertal vesicoureteral reflux.

BACKGROUND AND PURPOSE: Postpubertal vesicoureteral reflux is a rare occurrence. In the adolescent group, its repair can be a challenging open procedure. We present our preliminary experience with laparoscopic extravesical ureteral reimplantation for postpubertal vesicoureteral reflux. PATIENTS AND METHODS: Six female patients with a mean age of 18.7 years presented with recurrent urinary tract infection secondary to vesicoureteral reflux. The indications for treatment were febrile urinary tract infection, recurrent pyelonephritis, renal scarring, and breakthrough urinary tract infection. The reflux was unilateral in all patients at the time of treatment, but one patient had previously experienced bilateral reflux and had persistent left-sided reflux following subureteral injection of Durasphere. This patient underwent bilateral laparoscopic extravesical ureteral reimplantation. RESULTS: The mean operative times for the unilateral and bilateral procedures were 1.75 hours and 3.75 hours, respectively. The average length of stay in the hospital was 36 hours; five patients went home in <24 hours. The mean time to resumption of full activity was 8 days. All six patients had resolution of vesicoureteral reflux, as shown by radiographic studies, with a mean follow-up of 11.4 months. CONCLUSION: Laparoscopic extravesical ureteral reimplantation for postpubertal vesicoureteral reflux has excellent outcomes with minimal postoperative morbidity. Long-term radiographic follow-up is needed.

Adolescent↗
PubMed2000

Laparoscopic midsagittal hemicystectomy and replacement of bladder wall with small intestinal submucosa and reimplantation of ureter into graft.

BACKGROUND AND PURPOSE: A variety of biodegradable organic materials have been used for bladder wall replacement. In some instances, partial replacement has been done using laparoscopic reconstructive techniques. However, to date, this activity has been limited to small patches. Herein, we present the initial experience with laparoscopic sagittal hemicystectomy and the use of laparoscopic reconstructive techniques to replace half of the bladder with small-intestinal submucosa (SIS) and to reimplant the ureter into SIS. MATERIALS AND METHODS: Six female minipigs (20-25 kg) underwent transperitoneal laparoscopic sagittal hemicystectomy; the excised bladder wall was replaced with a 5 x 15-cm patch of SIS (Cook Biotechnology, Spencer, IN). The ipsilateral ureter was reimplanted through a small incision in the graft and secured with two sutures. Cystoscopy and cystometrograms were performed under general anesthesia preoperatively and at 6 and 12 weeks postoperatively. Tissues were harvested at 12 weeks. RESULTS: The procedure was successful in six animals (left three, right three). During cystoscopy at 12 weeks, the area of the graft was not distinguishable from normal mucosa. Cystometrograms revealed maintenance of volume and compliance, with volumes of 338, 343, and 369 mL and intravesical leak-point pressures of 37, 59, and 39 cm H2O at 0, 6, and 12 weeks, respectively. Antegrade ureterograms demonstrated extrinsic obstruction, minimal (two), moderate (three), or complete (one), at the ureterovesical junction. The kidney associated with the completely obstructed ureter was grossly hydronephrotic at sacrifice. Histologically, patchy epithelialization of the graft with a mixture of squamoid and mature transitional-cell epithelium was found. CONCLUSIONS: Laparoscopic hemicystectomy with replacement of the bladder wall and implantation of the ureter into the SIS graft is a feasible procedure. Clinical application awaits improvements in the method of ureteral reimplantation and longer follow-up to assess for ingrowth of muscle and nerve fibers.

Anastomosis, Surgical↗
PubMedDate not supplied

Intravesical robotically assisted bilateral ureteral reimplantation.

An efficient laparoendoscopic technique for bilateral intravesical ureteral reimplantation would offer the certainty of cure provided by open surgery with the reduced morbidity of laparoscopy. We have assessed the clinical utility of robotically assisted intravesical bilateral ureteral reimplantation in children. Ports are placed in the dome of the bladder, and the procedure is performed in a fashion identical to that used for open transtrigonal reimplantation. A catheter is left in place for 1 or 2 days. With modifications in port placement using the VersaStep radially dilating sheath system, we have not had any port-site leakage. One patient has unilateral persisting low-grade reflux. This technique may be a useful option for antireflux surgery and should be further refined.

Child, Preschool↗
PubMed2003

Successful reimplantation of a large segment of femoral shaft in a type IIIA open femur fracture: a case report.

Segmental bone loss associated with high-energy open fractures is a difficult problem. The more perplexing and controversial problem is that faced when the extruded segment of bone is retrieved from the field and available for potential reimplantation. Here we present successful reimplantation of a 13-cm segment of meta-diaphyseal femur in a 15-year-old boy. Successful reimplantation of the fragment was attributed to the anatomic location of the injury, meticulous wound care, multiple debridements, sterilization of the extruded fragment in chlorhexidine, and the patient's age.

Adolescent↗
PubMed2003

A novel technique for ureteral catheterization and/or retrograde ureteroscopy after cross-trigonal ureteral reimplantation.

PURPOSE: A criticism of the Cohen cross-trigonal reimplantation is the potential difficulty of retrograde access to the ureter. With the advent of modern endourological equipment, we devised a novel technique that obviates the aforementioned difficulty and permits even retrograde ureteroscopy. MATERIALS AND METHODS: Cystoscopy is performed and a curved tip vascular access catheter is directed towards the ureteral orifice. An angle tipped glide wire with a torque device attached is passed through the catheter and directed into the orifice. The combination of the curved catheter and angled glide wire permits passage of the wire in an axis perpendicular to that of the cystoscope. Once the glide wire has been passed into the proximal ureter it is exchanged for a super stiff guide wire. The latter literally straightens the ureter permitting direct retrograde passage of a catheter, stent or rigid ureteroscope. RESULTS: This technique was successful in 6 children. Of the patients 4 underwent retrograde ureteroscopy with stone extraction, 1 underwent retrograde studies followed by stent insertion and 1 underwent retrograde catheterization alone for radiographic studies. CONCLUSIONS: It is distinctly uncommon to have to access a ureter in a retrograde fashion after cross-trigonal reimplantation. However, when required the technique described reliably permits retrograde access and should dispel fears of long-term consequences of the Cohen ureteral reimplantation.

Adolescent↗
PubMed2005

Unilateral extravesical ureteral reimplantation in children performed on an outpatient basis.

PURPOSE: Unilateral extravesical ureteral reimplantation is comparable to intravesical procedures for resolution of primary vesicoureteral reflux (VUR). Defining whether this operation can be consistently performed on an outpatient basis is important. MATERIALS AND METHODS: A total of 80 patients with unilateral VUR were treated with extravesical ureteral reimplantation, of whom 20 were treated on an inpatient basis and 60 on an outpatient basis. We retrospectively reviewed these groups and conducted a telephone survey to evaluate overall patient satisfaction, and pain and nausea on postoperative days 1 and 14. RESULTS: There were no significant differences in age, gender, laterality or operative time between the groups. Average length of hospital stay was 31.25 hours (range 20 to 120) for the inpatient group and 6.6 hours (3.25 to 11.20) for the outpatient group. Average intravenous narcotic use in the inpatient group was 0.39 mg/kg, compared to 0.14 mg/kg for the outpatient group (p < 0.005), and included 1.76 mg/kg ketorolac in inpatients and 0.74 ketorolac in outpatients (p < 0.005), and 0.2 mg/kg ondansetron in inpatients and 0.12 mg/kg ondansetron in outpatients (p = 0.004). Four of the 60 outpatients (6.7%) were either hospitalized postoperatively or rehospitalized on postoperative day 1. The results of the survey for the 2 groups were not significantly different. CONCLUSIONS: Extravesical ureteral reimplantation for unilateral VUR may be performed without compromise in quality on an outpatient basis with significantly less use of intravenous analgesics and anti-emetics.

Ambulatory Surgical Procedures↗
PubMed2006

Elimination of facial nerve stimulation by reimplantation in cochlear implant subjects.

HYPOTHESIS: Perimodiolar intracochlear electrodes with contacts facing towards the modiolus have limited current flow towards the outer wall of the cochlea and therefore, may reduce the occurrence of facial nerve stimulation (FN) in cochlear implant subjects. BACKGROUND: Facial nerve stimulation is a well-known complication in cochlear implant treatment especially in the group of subjects with otosclerosis. The possible explanation of this side effect is a change of the electrical properties of the otosclerotic bone leading to leakage current and resulting in facial nerve stimulation. METHODS: Four CI subjects who had been implanted with a Nucleus Mini22 device with a Nucleus Straight electrode between 9 to 12 years ago suffered from severe FN stimulation. Electrode contacts had to be switched off so that they could only use 4, 11, 13, and 15 electrodes of their usual set of 22. The switch off resulted in deteriorating speech understanding over time. Therefore, all subjects were reimplanted with a Nucleus 24R device with a Contour electrode. Preoperatively, the threshold of FN stimulation was obtained on all electrodes subjectively. Intraoperatively, FN stimulation thresholds were measured objectively with both, the old and the new device and were compared. NRT and SRT thresholds were also obtained with the reimplanted device to assure effective electrical stimulation of the auditory nerve. RESULTS: In all four cases the postoperative fitting demonstrated no FN stimulation on all electrodes up to maximum comfortable level. The insertion of the Contour electrode array was complete in three cases, in one case the array could only be inserted partially similarly to the situation before the reimplantation. Speech perception tests showed a significant improvement in all subjects with the new device. CONCLUSION: Electrodes with modiolar facing contacts and perimodiolar position like the Nucleus Contour electrode reduce the possibility of facial nerve stimulation significantly due to more focused electrical stimulation.

Adult↗