Ureteral reimplantation: Cross-trigonal approach
The Cohen cross-trigonal ureteral reimplant is perhaps the most commonly performed open reimplant procedure, particularly for correcting bilateral vesicoureteral reflux. Its high success rate and low complication rate have made it a reliable surgery for over 40 years. A criticism of the technique is that it renders future retrograde access to the ureters extremely difficult. Subtle variations in surgical technique and postoperative management are found among different pediatric urologists, such as the need for stents or catheter drainage, but the basic surgical principles are presented here.
Dr. Hotaling: Drs. Wallis, Lau, and Cartwright demonstrate how to perform a complex procedure through a small, carefully placed incision. They use meticulous tissue handling and clear identification of tissue planes to identify, mobilize, and move the ureters. These techniques are broadly applicable to any ureteral surgery and serve to provide a safe and clear approach to intravesical ureteral identification and mobilization.
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