Extravesical repair for vesicoureteral reflux

Composite drawing demonstrating sequential steps required for extravesical repair for vesicoureteral reflux.

(A) Bladder mucosa is elevated off bladder wall muscle and vest-type sutures are placed.
(B) Sagittal section shows suture passing between undermined mucosa and detrusor.
(C) Alignment of vest sutures after placement.
(D) Sagittal section demonstrates appropriate positioning of sutures.
(E) Tying vest sutures advances and anchors ureter onto trigone.
(F) Sagittal section of ureteromeatal advancement (arrow reflects advancement of distal ureter within the detrusor tunnel).
(G) Closure of detrusor flaps over ureter allows for long submucosal tunnel and completes detrusorrhaphy.