Technical details of Cohen procedure for children suffered from megaureter and prevention and treatment of its complications

Objective To analyze the technical details of Cohen procedure for children suffered from megaureter and prevention and treatment of its complications. Methods Seventeen children with megaureter admitted to our hospital from March 2004 to December 2011 were treated by Cohen procedure. The pathological states of the ending portion of the megaureter, the indications of extravesical and intravesical dissection, the causes of postoperative complications of urinary infection, bleeding and urinary leakage were analyzed so as to evaluate the importance of the technical skills for the prevention of complications. Results Of the 17 children suffered from megaureter, including 9 boys and 8 girls, aging from 1 to 13 years old, with a mean age of 6.02 years old, 15 cases were found to have ureteral stricture and 2 cases were ureteral refluxing. The diameters of the ending portion of magaureter ranged from 0.5 to 3.2 cm, with the mean value of 1.72 cm. 15 patients were operated through intravesical dissections and 2 obtained the union of intravesical and extravesical dissections. 5 patients presented with peri-operative complications, including 2 patients with urinary infections, 3 patients with bleeding of bladder, and 2 patients with urinary leakage. Conclusion The key points of improving the success of Cohen procedure for children with magaureter includes the ligation of vessels in ureteral mesentery and cutting circumcision, no-tension anatomosis of ureter and bladder during reimplantation, combination of extra and intra vesical dissections in the process of intra vesical dissection, control of the urinary infection and a completely normal coagulation states preoperatively.