Uretero-Vesical Reimplantation Techniques According to Nesbit and Leadbetter Politano: Indications, Surgical Techniques and Results in Two Teaching Hospitals of Cameroon

Abstract

Introduction: The aim of this study is to determine the indications, surgical techniques and results related to ureterovesical reimplantation surgery based on two surgical techniques known and practiced daily in two university teaching hospitals in Cameroon. Materials and Methods: This is an observational longitudinal study with retrospective and prospective data collection arms over a 10-year 5-month period in the Urology and Andrology departments of the Yaoundé Central Hospital (YCH) and at the Douala Laquintini Hospital (DLH). The retrospective arm spanned from January 2012 to December 2022 and the prospective one from January 2023 to July 2023. R e sults: 27 patients were recruited for the purpose of this study with a mean age of 42.5 ± 7.5 years. The age range was from 35 to 50 years. The sex ratio (F/M) was 4.4 and the frequency of this surgical intervention was 2.7 cases/year. Delay to consultation and subsequent management were respectively 30 (7 - 150) and 90 (14 - 150) days on average. The clinical presentation was dominated by lower back pain on the ipsilateral side in all patients and permanent intravaginal urine leak in female patients. It should also be noted that damage to the pelvic ureter was the most common pathology found in women, seen on the right side in 14 cases. Ultrasound scan and CT urography were the most used imaging techniques for diagnosis in 85.2% and 44.4% respectively. Uretero-hydronephrosis was discovered in 22 patients with preservation of renal parenchyma architecture. We had 20 (74.1%) patients who presented with iatrogenic trauma of the ureter, 63% of which was secondary to hysterectomy and 11.1% post cesarean section. All our patients were operated by open surgery and the initial intraoperative lesion discovered was ligation of the pelvic ureter, seen in 13 (48.1%) patients. Direct Uretero-vesical reimplantation according to the Nesbit technique was carried out in 55.6% of cases and that by Leadbetter Politano in 14.8%. The postoperative period was satisfactory in 15 patients. Surgical site infections were recorded in 7 (25.9%), and intraoperative bleeding was seen in 4 (14.8%) other patients. We recorded 1 death in this study, occurring on the 21st day post-operation. It was secondary to chemical peritonitis. The average post op hospital stay was 15 (13 - 19) days and follow-up visits after 48 (34.5 - 85.5) months revealed patients who were asymptomatic at the time of reassessment, without elevation in serum creatinine, urinary infections, nor fistula formation. Conclusion: The results of ureterovesical reimplantation techniques according to Nesbit and Leadbetter Politano in our study had a very satisfactory clinical success rate.