ABSTRACT
In 1960, Hodson and Edwards clarified the relationship between vesicoureteric reflux and renal damage and stressed the importance of pyelotubular backflow of urine into certain papillae. The approach to the bladder, the retraction with the Denis Browne retractor, and the exposure of the bladder mucosa are as in the transhiatal procedure. In the Puigvert technique, the ureter is divided in a healthy zone and pulled into the bladder where it is attached by a direct circular anastomosis at the site of the original meatus. The Cohen procedure permits the creation of a longer tunnel and reduces the risk of ureteral obstruction, but it makes further endoscopic procedures more difficult. As for open surgery, micturating cystogram is not routinely performed. The ureteral dissection follows the Cohen technique using the hook and a pledget. The success rate is equivalent to the open Cohen procedure with much less postoperative discomfort.
