Pneumovesicoscopic Correction of Primary Vesicoureteral Reflux (VUR) in Children. Our Experience

Abstract

Aim: We report our experience with pneumovesicoscopic cross-trigonal ureteral reimplantation to correct primary vesicoureteral reflux (VUR) in children.

Material and Methods: 14 children (10 girls, 4 boys, aged 4 to 12 years) with persistent VUR≥grade III (5 bilateral, 19 refluxing ureters) underwent pneumovesicoscopic Cohen's cross-trigonal reimplantation. Under cystoscopic control, a first midline 5-mm trocar was introduced for a 0°\30° telescope at the dome of the bladder, and 2 left and right 3- or 5-mm trocars were inserted through the anterolateral wall. The ureter was freed by creating a sharp plane between the detrusor muscle and the ureteral wall. If necessary, the ureter was tailored outside the bladder. Submucosal tunnel(s) were prepared with the help of scissors and graspers. The detrusor at the site of the ureter mobilization was repaired and ureteroneocystomy was performed using 4–5 interrupted absorbable sutures. A 12-Ch Foley catheter was introduced at the site of the dome port. The urethral and suprapubic catheters were removed 2–3 days after the procedure and the patients were discharged on day 3.

Results: One boy developed mild suprapubic emphysema postoperatively. Mean operating time was 136 min (range 80–230 min). No patient required conversion to the open technique. Renal US, VCUG, and MAG3 radionuclide scans were obtained in all patients between 3–6 months postoperatively, and provided evidence of reflux resolution in 13 out of 14 patients.

Conclusion: Our experience seems to confirm that pneumovesicoscopic cross-trigonal ureteral reimplantation can be performed safely and effectively.

Key words

vesicoureteral reflux - laparoscopy - pneumovesicum - cross-trigonal reimplantation

References

• 1 Elder JS, Peters CA, Arant Jr BS. et al . Pediatric vesicoureteral reflux. Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children.  J Urol. 1997;  157 (5) 1846-1851
• 2 Elder JS, Diaz M, Caldamone AA. et al . Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection.  J Urol. 2006;  175 (2) 716-722
• 3 Atala A, Kavoussi LR, Goldstein DS. et al . Laparoscopic correction of vesicoureteral reflux.  J Urol. 1993;  50 748-751
• 4 Jayanthi V, Patel A. Vesicoscopic ureteral reimplantation: A minimally invasive technique for the definitive repair of vesicoureteral reflux.  Adv Urol. 2008;  973616. Published online 2008 November 5. doi: 10.1155/2008/973616
• 5 Marte A, Sabatino MD, Borrelli M. et al . Pneumovesicoscopic treatment of congenital bladder diverticula in children: our experience.  J Laparoendosc Adv Surg Tech. 2010;  20 (1) 87-90
• 6 Heidenreich A, Ozugur E, Becker T. et al . Surgical management of vesicoureteral reflux in pediatric patients.  World J Urol. 2004;  22 96-106
• 7 Durai R, Ng PC. Spaghetti technique – novel technique to facilitate laparoscopic appendicectomy and cholecystectomy.  J Laparosc Adv Surg Tech. 2009;  19 (5) 667-668
• 8 Valla JS. Transvesicoscopic Cohen ureteric reimplantation for vesico-ureteral reflux in children.. In: Godbole PP (ed.) Pediatric Endourology Techniques Springer-Verlag: London; 2007: 39-46
• 9 Yeung CK, Borzi Pa. Pneumovesicoscopic Cohen ureteric reimplantation with carbon dioxide bladder insufflation for gross VUR.  Br J Urol Int. 2002;  89 (2) 15-86
• 10 Seseke F, Strauss A, Seseke S. et al . Long-term experience with Cohen ureteral reimplantation in bilateral vesicoureteral reflux in childhood.  Urologe. 2006;  5 (7) 852-857
• 11 Duong DT, Parekh DJ, Pope 4th JC. et al . Ureteroneocystostomy without urethral catheterization shortens hospital stay without compromising postoperative success.  J Urol. 2003;  170 1570-1573
• 12 Miller OF, Bloom TL, Smith LJ. et al . Early hospital discharge for intravesical ureteroneocystostomy.  J Urol. 2002;  167 (6) 2556-2559
• 13 Chamie K, Chi A, Hu B. et al . Contemporary open ureteral reimplantation without morphine: assessment of pain and outcomes.  J Urol. 2009;  182 1147-1151
• 14 Palmer JS. Bilateral extravesical ureteral reimplantation in toilet-trained children: short-stay procedure without urinary retention.  Pediatric Urol. 2009;  75 285-288
• 15 Yeung CK. Endoscopic cross-trigonal ureteric reimplantation under carbon dioxide pneumovesicum.. In: Bax KMA, Georgeson KE, Rothenberg SS, Valla JS, Yeung CK (eds.) Endoscopic Surgery in Infants and Children Springer-Verlag, Berlin Heidelberg; 2008: 727-773
• 16 Lipski BA, Mitchell ME, Burns MW. Voiding dysfunction after bilateral extravesical ureteral reimplantation.  J Urol. 1998;  159 1019-1021
• 17 Kirsch AJ, Kaye JD, Cerwinka WH. et al . Dynamic hydrodistention of the ureteral orifice: a novel grading system with high interobserver concordance and correlation with vesicoureteral reflux grade.  J Urol. 2009;  182 (Suppl. 4) 1688-1692
• 18 Yeung CK, Sihoe JD, Borzi PA. Endoscopic cross-trigonal ureteral reimplantation under carbon dioxide bladder insufflation: a novel technique.  J Endourol. 2005;  19 295-299
• 19 Kutikov A, Guzzo TJ, Canter DJ. et al . Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia.  J Urol. 2006;  176 2222-2226
• 20 Peters CA, Woo R. Intravesical robotically assisted bilateral ureteral reimplantation.  J Endourol. 2005;  19 (6) 618-622
• 21 Valla JS, Steyaert H, Griffin SJ. et al . Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience.  J Pediatr Urol. 2009;  5 (6) 466-471

Correspondence