Experimental Ureteroneocystostomy in Dogs: Simple Free end Method and Modified Politano-Leadbetter Method / 대한비뇨기과학회지

ABSTRACT

Politano-Leadbetter method has been widely used in ureteroneocystostomy these days, we encounter some cases not suitable for this method, For example, in case the ureter was not properly long enough or in the process of making submucosal tunnel vesical mucosa happens to be irregulary dissected due to vesical inflammation, other useful method of vesicoureteral reimplantation is necessary. therefore, instead of making the submucosal tunnel, enough length of the intravesical ureter, which was the most important factor in preventing vesicoureteral reflux, was made protruded into the bladder lumen with free end method and modified Politano-Leadbetter method. these maneuvers well permit value-like flatting or closing of the distal ureteral segment during periods of increased intravesical pressure. We have performed experimental ureteroneocystostomy in 8 dogs, 16 ureters with simple free end method (group 1) and modified Politano-Leadbetter method(group 2)in two groups and two dogs were used as control. The procedure of free end method is a no-tunnel `drop-in` with a long segment protruding into the bladder lumen and that of modified Politano-Leadbetter method is as follows. The intravesical ureter is placed beneath the incised bladder mucosa without submucosal tunnelling and the spatulated distal end of the ureter is sutured with bladder mucosa. In control group ureteroneocystomy was performed by Politano-Leadbetter method. The roentgenographic findings and gross appearance of the kidney and ureter were observed in the 5 weeks after the operation. The anastomosis site was also observed histologically. The results obtained were as follows 1. No vesicoureteral reflux was found cystographically in both group. 2. Hydronephrosis and obstruction at the anastomosis site were found in one out of 8 ureters in each group by intravenous urography. 3. Renal enlargement and chronic inflammation and fibrosis at the anastomosis site were noted in one out of 8 ureters in each group by gross and microscopical examination. 4. In group 2, modified Politano-Leadbetter method, it was found that the intravesical ureter was covered by regenerated vesical submucosal tissue microscopically. Through this study it is concluded that these two methods are useful to be performed for the ureteroneocystostomy when the submucosal tunnel technique is not suitable.