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S4-17
(P)
EVALUATION OF MATHISEN'S TECHNIQUE FOR URETERAL REIMPLANTATION IN
CHILDREN WITH PRIMARY VESICOURETERAL REFLUX
Bernhard HAID, Christa STRASSER, Tanja BECKER, Mark KOEN, Christoph BERGER and Josef OSWALD
Hospital of the Sisters of Charity, Department of Pediatric Urology, Linz, AUSTRIA
INTRODUCTION
Although cross-trigonal ureteral reimplantation (Cohen) is the most commonly used technique in children, it respresents
an unphysiological transfer of the ureteral orifices. Extraanatomical ureteral reimplantation may result in difficulties
during ureteral instrumentation later in life. W.Mathisen in 1964 described an alternative method of ureteral
reimplantation with lateralization of the neohiatus creating an orthotopic course of the submucosal tunnel which is long
enough to ensure antirefluxive length. We retrospectively evaluated success as well as complication rates of both
techniques.
PATIENTS AND METHODS
48 consecutive patients (83 ureters, 24 males/24 females, median age 2,01 years) after Mathisen’s reimplantation were
compared to 53 consecutive patients (99 ureters, 30 males/23 females, median age 1,4 years) after Cohen’s
reimplantation. Inclusion criterion was primary vesicoureteral reflux (VUR) and no previous intervention. Reflux grades
(Mathisen °0-°2[contralateral] 25/30,1%, ≥°3 58/69,9%; Cohen °0-°2[contralateral] 32/32,3%, ≥°3 66/66,7%).
RESULTS
After Cohen’s reimplantation there were no immediate complications, during follow-up (median follow-up 24,5 months)
3 patients (5,6%) suffered febrile UTIs, thereof 1 (1,8%) was diagnosed with a persisting VUR. Persistent
hydronephroses were recorded in 7 patients (13,2%).
After reimplantation using Mathisen’s technique 2 patients (4,1%) suffered significant intravesical bleeding, during
follow-up (median follow-up 11,5 months) 4 patients (8,3%) suffered febrile UTIs and a total of 7 patients (14,5%)
were diagnosed with persisting VUR. 2 patients (4,1%) had persistent hydronephroses.
CONCLUSIONS
Despite the advantages of an orthotopic ureteral orifice close to the bladder neck, Mathisen’s technique for ureteral
reimplantation yielded an inferior success rate (85,5%) in comparison with Cohen’s reimplantation technique (98,2%) as
judged from our series of only patients undergoing the first antireflux intervention. This may be partly explained by a
lower level of experience in some of the surgeons in the Mathisen’s group. Although there was no intervention for
obstruction, persistent hydronephroses were more common in the Cohen group (13,2% vs. 4,1%).