Initial Experience With Laparoscopic Transvesical Ureteral Reimplantation at the Children’s Hospital of Philadelphia (original) (raw)
Related papers
Robotic-assisted laparoscopic extravesical ureteral reimplantation: An initial experience
Journal of Pediatric Urology, 2012
Objective: There are many emerging techniques using robotic-assisted laparoscopy (RAL) in pediatrics. We performed a retrospective review of our first patients who underwent RAL extravesical ureteral reimplantation. a single surgeon performed RAL extravesical ureteral reimplantation in 17 patients. Six patients underwent bilateral reimplantation, resulting in a total of 23 ureters repaired. There were 16 females and 1 male (mean age 6.23 years). Four patients had prior Deflux injection. Postoperative reflux status was assessed by voiding cystourethrogram. Results: 16 patients (22 ureters) were compliant with follow up. Mean follow up was 11.5 months. Mean anesthetic time was 3 h, 57 min for unilateral and 4 h, 45 min for bilateral repair. Complete vesicoureteral reflux resolution was seen in 20 ureters (90.9%), downgrading in one ureter, and unchanged persistent reflux in one ureter. Average hospital stay was 1.3 days. No patients required postoperative catheterization at discharge. Conclusions: Outcomes for new procedures can be variable and unpredictable as the technique evolves. Given the high success rates of open reimplantation, a minimally invasive technique must show comparable results if it is to play a continuing role. Our initial results are encouraging, but prospective analyses are required to outline the future role of RAL ureteral reimplantation.
Methodology Report Laparoscopic Extravesical Ureteral Reimplantation: Technique
Laparoscopic extravesical ureteral reimplantation in children is currently a technically demanding procedure with sparse literature to aid in mastering the learning curve. We present our most recent technique and lessons learned after 20 cases in children 4-15 years of age. The literature is also reviewed to encapsulate the current state-of-the-art.
Laparoscopic re-implantation of refluxing ureter in children: A feasibility study
Arab Journal of Urology, 2017
To report our initial experience in the application of laparoscopy in the management of children with unilateral vesico-ureteric reflux (VUR) using the laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique, and to evaluate the results and benefits of this technique for such patients. Patients and methods: Between February 2013 and August 2014, 17 children [13 girls and four boys, with a median (range) age of 60 (24-120) months] presented with recurrent febrile urinary tract infections and were diagnosed with unilateral VUR. They underwent transperitoneal extravesical laparoscopic ureteric re-implantation following the Lich-Gregoir technique. Postoperatively abdomino-pelvic ultrasonography was done at 1 month after surgery and voiding cystourethrography (VCUG) at 3 months after surgery, and in cases with persistent VUR or de novo contralateral VUR another VCUG was done at 6 months after surgery. Results: The median (range) operative time was 90 (80-120) min and the postoperative hospital stay was 2 (2-5) days. Intraoperative and postoperative complications were minimal. Patients were followed-up for a median (range) of 6 (3-21) months. All the children had complete resolution symptomatically and on VCUG, without further intervention. Conclusions: The laparoscopic extravesical transperitoneal approach for ureteric re-implantation, following the Lich-Gregoir technique, is feasible and very effective
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012
Purpose: Minimally invasive approaches to the surgical management of vesicoureteric reflux (VUR) have become more prominent over the last 10 years with progress in both endoscopic and laparoscopic/robotic surgery. We hypothesized that laparoscopic extravesical detrussoraphy (LED) for the management of VUR in children with complex bladders and/or bilateral VUR was safe and effective. Subjects and Methods: Under institutional review board approval we evaluated the charts of all patients seen at our institution over the last 8 years who had undergone LED for the management of VUR. We evaluated demographic variables, surgical variables, and postoperative results. Postoperative bladder function was examined in the patients as well as need for secondary procedures. Patients with complex bladders included all patients who had previous surgery on the affected side, neurogenic bladders, and duplex or complex anatomy. Results: Ninety-eight patients with 144 ureters were treated during this time period. The overall VUR resolution by voiding cystourethrogram was 95.2%. The average age was 6.74 years, with 13 children over the age of 12 years old. Average length of stay (LOS) was 1.7 days for children 5 years and older and 1.0 days for children less than 5 years old (P = .004). LOS was not affected by body mass index or complexity of the procedure. There were 46 bilateral procedures, and the incidence of urinary retention was 6.5% versus 0% in the unilateral group (P = .09). Of our patients, 27.6% had complex bladders, including 9 patients with complete ureteral duplications, 10 with periureteral diverticula, and 8 with prior surgery on the affected side. There were two complications requiring a second procedure in this group (7%). No patient with a complex bladder had persistent VUR. Conclusion: LED for the management of children with complex bladders and VUR is safe and effective. This technique is versatile and achieves high VUR resolution rates with minimal morbidity.
Laparoscopic Ureteral Reimplantation: Technique and Outcomes
Purpose: We describe our experience with laparoscopic ureteral reimplantation in 45 adults, and report success rates and complications at intermediate term followup. Materials and Methods: We performed a retrospective chart review of 45 patients who underwent laparoscopic ureteral reimplantation between 1997 and 2007. Demographics, clinicopathological parameters, perioperative course, complications and followup studies were analyzed. Results: Elective laparoscopic ureteral reimplantation was performed in 35 female and 10 male patients with a mean followup of 24.1 months (range 1 to 76). All patients presented with distal ureteral stricture with a mean stricture length of 3 cm and a mean SD preoperative serum creatinine of 0.91 0.04 mg/dl. Mean patient age was 47.8 2.2 years (range 17 to 87). Mean American Society of Anesthesiologists score was 2 (range 1 to 3). Median estimated blood loss was 150 ml. The overall success rate, defined as radiographic evidence of no residual obstruction, symptoms, renal deterioration or need for subsequent procedures, was 96%. Two patients had recurrent strictures and 1 underwent nephrectomy for flank pain and preexisting chronic pyelonephritis. Conclusions: According to intermediate followup data laparoscopic ureteral re-implantation can be performed with an excellent success rate and low morbidity. Our data substantiate this technique as an effective method for managing distal ureteral stricture.
Ureteral Reimplantation in Infants and Children: Effect on Bladder Function
The Journal of Urology, 2002
Purpose: We investigate whether early ureteral reimplantation in infants damages the urodynamic behavior of the bladder compared to ureteral reimplantation after age 1 year. We also evaluate changes in bladder behavior after ureteral reimplantation. Materials and Methods: We compared 2 groups of 25 children each who underwent ureteral reimplantation. Group 1 included children younger than 12 months at surgery, and group 2 children were between 1 and 10 years old. All patients had grade III or greater reflux in 1 or 2 ureters, or obstructed megaureters. All patients underwent a complete urodynamic study before and after surgery. We analyzed preoperative and postoperative differences in urodynamic studies in both groups concerning bladder instability, capacity and compliance. Results: Our analysis of urodynamic data showed that bladder instability was reduced more in group 1 than group 2, although not statistically significant. Parameters for bladder capacity and compliance were comparable for both groups. No statistically significant difference was noted between the urodynamic results in both groups preoperatively and postoperatively. Conclusions: No difference in urodynamic parameters could be found between children younger than 12 months compared to those older who underwent ureteral reimplantation. The urodynamic data do not provide any contraindication to ureteral reimplantation performed in early infancy. Moreover, except for a minor reduction in bladder instability, ureteral reimplantation does not alter the urodynamic behavior of the bladder.
Intravesical Ureteric Plication and Reimplantation for Megaureters in Children
British journal of urology, 1993
Historically, megaureters have always been a surgical dilemma for paediatric urologists. However, the evolution of modern diagnostic and surgical methods such as tailoring, folding and plication have made it possible to ensure successful correction in most patients. We report 17 megaureters (11 refluxing and 6 obstructing) in 11 children who were treated with intravesical plication and the transtrigonal advancement technique between January 1986 and April 1991. Results were excellent in 11 ureters and satisfactory in 4. In one ureter additional surgery was needed because of obstruction at the implantation site and in another ureter reflux persisted. Intravesical plication and reimplantation is a good alternative procedure for grossly dilated ureters owing to its low morbidity and high success rate.