Use of pneumovesicoscopic access for removal of the ureteral stump in patients with duplication of the urinary tract

Afunctional compromise of the upper segment of the duplex kidney often necessitates a heminephrureterectomy. Refluxing distal ureters most often persist after staged surgical interventions in patients with complete duplication of the urinary tract. This procedure does not always allow complete removal of the ureter down to its entry into the bladder. As a result, urine reflux into the distal ureter persists, triggering clinical manifestations and impairing the child’s quality of life, necessitating its removal. Objective. To demonstrate the successful use of pneumovesicoscopic access in providing surgical care to patients with reflux into the ureteral stump after staged surgical interventions. Materials and methods. In patients with complete duplication of the urinary tract, an obstructive upper-segment megaureter with ureterocele was initially diagnosed. The children initially underwent endoscopic ureterocele dissection. Subsequently, laparoscopic heminephrureterectomy/nephroureterectomy was performed due to the lack of function. During follow-up and examination due to recurrent dysuria and inflammation, reflux into the ureteral stump was detected, necessitating the selection of a further, justified surgical approach and treatment strategy. Results. The use of a pneumovesicoscopic approach for ureteral stump removal in patients following staged surgeries is minimally invasive and noninvasive, allowing for optimal access to the distal ureter and shortening the hospital stay due to rapid recovery and adaptation. The follow-up period lasted over a year: no symptoms of dysuria or recurrent urinary tract infections were observed during this observation period. Conclusions. In case of formation of a refluxing ureteral stump in patients after organ-removing operations, endovideosurgical pneumovesicoscopic access can be proposed as an effective and justified approach.

1. Vrublevskij A.S., Poddubnyj I.V. Endovideosurgical interventions for the treatment of pathology of ureterovesical junction in children. Detskaya hirurgiya. 2017; 21(1): 38-41 (in Russ.) DOI: 10.18821/1560-9510-2017-21-1-38-41

2. Gnech M., Hoen L., Zachou A., Bogaert G., Castagnetti M., O’Kelly F. et al. Update and Summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children. Eur Urol. 2024;85(5):433-442. DOI: 10.1016/j.eururo.2023.12.005

3. Kozlov Yu.A., Rasputin A.A., Koval’kov K.A., Baradieva P.Zh., Ochirov Ch.B., Kapuller V.M. Laparoscopic heminephrectomy in children. Detskaya hirurgiya. 23(5): 264-269 (in Russ.) DOI:10.18821/1560-9510-2019-23-5-264-269

4. Okamura K., Ono Y., Yamada Y., Kato T., Tsuji Y., Ohshima S. et al. Endoscopic trigonoplasty for primary vesico-ureteric reflux. Br. J. Urol 1995;75(3):390e4. DOI: 10.1111/j.1464-410x.1995.tb07355.x

5. Yeung C.K., Sihoe J.D., Borzi P.A. Endoscopic cross-trigonal ureteral reimplantation under carbon dioxide bladder insufflation: a novel technique. J Endourol. 2005;19(3):295-9. DOI: 10.1089/end.2005.19.295

6. Cui X., Huang W.H., Wang Y.J., Chen L., Zhang J.Q., Zhou C.M. Effect of pneumovesicoscopic cohen surgery with adjustable suspension technique through the urethra on the treatment of primary vesicoureteral reflux disease in infants. BMC Surg. 2023;23(1):105. DOI: 10.1186/s12893-023-01996-7

7. Chen H., Cui X., Zhou C., Zhang J., Chen L. The effect of pneumovesicoscopic Cohen surgery using a segmented submucosal tunnel and reduced intra-abdominal pressure for the treatment of vesicoureteral reflux in children. Front Pediatr. 2025. 12; 13: 1709328. DOI: 10.3389/fped.2025.1709328

8. Karpachev A.S., Zorkin S.N., Gurskaya A.S., Tarzyan A.O., Bayazitov R.R., Zhamynchiev Eh.K. et al. The first experience of pneumovesicoscopic ureteral reimplantation in children under 2 years of age. Detskaya hirurgiya. 2020; 24(5): 303-306. (in Russ.) DOI: 10.18821/1560-9510-2020-24-5-303-306

9. Rudin Yu.Eh., Maruhnenko D.V., Galickaya D.A., Aliev D.K., Lagutin G.V., Vardak A.B. Possibilities of pneumovesicoscopic access for correcting ureterovesical segment pathology in children. Urologiya. 2021; 1: 95-102. (in Russ.) DOI: 10.18565/urology.2021.1.95-102

10. Tao C., Cao Y., Mao C. Surgical removal of primary bladder diverticulum in children under pneumovesicum laparoscopy. Asian J Surg. 2023;46(12):5521-5522. DOI: 10.1016/j.asjsur.2023.07.140

11. Cezarino B.N., Lopes R.I., Berjeaut R.H., Dénes F.T. Can extended upper pole ureterectomy prevent ureteral stump syndrome after proximal approach for duplex kidneys? Int Braz J Urol. 2021;47(4):821-826. DOI: 10.1590/S1677-5538.IBJU.2020.0686

12. Jeon B.J., Tae B.S., Yoo J.W., Koo H.Y., Oh C.Y., Park J.Y. et al. Pneumovesical vesicovaginal fistula repair: Lessons learned from an initial series of 25 patients. Int J Urol. 2024;31(10):1080-1086. DOI: 10.1111/iju.15508

13. Lui H., Onyeji I., Durbin-Johnson B.P., Kurzrock E.A. Preoperative factors associated with the development of distal ureteral stump syndrome after upper pole heminephrectomy. J Pediatr Urol. 2023;19(6):782.e1-782.e6. DOI: 10.1016/j.jpurol.2023.09.001