ESPU Congress 2018 - Abstract Book

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198 29th CONGRESS OF THE ESPU
VD-4 (VS without presentation)
LAPAROSCOPIC EXTRAVESICAL URETERAL
REIMPLANTATION TECHNIQUE AFTER
FAILED‑ENDOSCOPIC SURGERY FOR VESICOURETERAL
REFLUX
Jenny ARBOLEDA, Oriol MARTÍN-SOLÉ, Sonia PÉREZ-BERTÓLEZ and Luis
GARCÍA-APARICIO
Hospital Sant Joan de Déu, Pediatric Urology, Pediatric Surgery, Barcelona, SPAIN
PURPOSE
Ureteral reimplantation should be considered for treating persistent vesicoureteral reflux (VUR)
after endoscopic treatment. Laparoscopic extravesical ureteral reimplantation is gaining popularity
on recent years. We present a video of laparoscopic extravesical ureteral reimplantation after two
failed endoscopic surgeries for VUR.
MATERIAL AND METHODS
A 2-year-old boy with persistent left grade IV VUR after two failed endoscopic treatments, with 22 %
differential renal function on DMSA-scan was operated. The patient was placed in Trendelenburg
position and a Foley catheter was inserted. Open trocar placement was done at the umbilicus
(5 mm). The other two 3 mm trocars were placed along the lateral border of the rectus. The perito-
neum was opened over the posterior bladder wall and the distal ureter was dissected, taking care
not to damage the vas deferens. A transabdominal hitch suture through the bladder was used to
expose its posterior wall. The position bladder through was marked with hook electrocautery and
the muscle fibres were divided with sharp scissors until the mucosa bulged. The bladder was filled
with physiological saline to expose and identify the mucosa, which facilited the detrusorraphy with
5–0 vicryl.
RESULTS
The Foley catheter was removed after 24 hours and the patient was discharged. The postoperative
voiding cystourethrogram showed resolution of VUR
CONCLUSIONS
Laparoscopic extravesical ureteric reimplantation represents a feasible, safe and low morbidity
technique for retreatment of VUR in children.
VD-5 (VS without presentation)
ROBOT-ASSISTED LAPAROSCOPIC DISMEMBERED
URETERAL REIMPLANT WITH TAPERING
Diana K. BOWEN1 , Aseem R. SHUKLA2 and Arun K. SRINIVASAN1
1) The Children's Hospital of Philadelphia, Division of Pediatric Urology, Department of Pediatric Surgery, Philadelphia,
USA - 2) The Children's Hospital of Philadelphia, Division of Pediatric Urology, Department of Surgery, Philadelphia, USA
PURPOSE
Primary obstructive megaureter represents a challenging case robotically as the ureter is not only
dilated but often tortuous and redundant. We demonstrate our technique for a robotic dismembered
tapered ureteral reimplant, emphasizing the ureteral anastomosis and tapering components.