Computer-Enhanced Visual Learning Method to Teach Endoscopic Correction of Vesicoureteral Reflux: An Invitation to Residency Training Programs to Utilize the CEVL Method
Figure 5
Procedure as CEVL components in a case of grade IV reflux in an infant girl. (a) Ureter orifice injection sequence. Inner margin of orifice (top left). Needle tip targets the injection site into the inner margin of ureter orifice (top right overlay). Bottom right: needle tip has penetrated inner margin of ureter orifice. (b) Injection at inner margin of orifice is now complete as the orifice is raised further above bladder surface. Hole in mucosa represents previous needle penetration. This component is complete as this appearance shows that the implant mound obscures view of the ureter lumen and has further elevated the ureter orifice. (c) Outer margin of ureter orifice sequence. Left: needle tip targets next injection at the outside margin of orifice. Right: after injection there is additional bulking of the orifice which is further elevated (graduated rule). There is an insignificant blood stream from the site of previous injection. This component is complete as the implant injection further elevates the ureter orifice. (d) Base of ureter orifice injection sequence. (a) Needle tip targets injection site at base of mesa. (b) After injection. This component is now complete as the mesa is further elevated (graduated rule), ureteral meatus is slit-like (blue crescent), and the meatus does not show hydrodistention (not shown). This appearance is compared with the icon representing the orifice before reconstruction.
