210 / 238
210
29
th
CONGRESS OF THE ESPU
MATERIAL AND METHODS
A total of 10 patients underwent laparoscopic transvesical bilateral reimplantation by the same
surgeon. All the 6 patients had primary VUR. Of these 9 had grade II-III VUR while 1 had grade
IV on one side and III on other side. Laparoscopic transvesical bilateral cross-trigonal ureteral
reimplantation was performed in all the patients. A pure laparoscopic approach using three 3/5 mm
ports was used.
RESULTS
The median age was 4.5 years [range 3–8]. The median operative time was 150 minutes [range
130–180]. There was no conversion or any intraoperative complication reported. Median hospital
stay was 6 days [range 5–8]. The median follow up is 18 months. On follow up renal dynamic scans
normal drainage was reported in all the patients. Reflux resolved in 9 patients. In 1 patient reflux
persisted of the same grade i.e. grade IV on one side. This patient had tortuous and dilated ureter
[Grade IV] on preoperative voiding cystourethrogram.
CONCLUSIONS
Laparoscopic bilateral transtravesical reimplantation is safe and feasible. Dilated and tortuous
ureters [VUR grade IV] are best to be avoided for this technique.
VD-22 (VS without presentation)
VESICOSCOPIC CROSS-TRIGONAL URETERAL
REIMPLANTATION
Venkata JAYANTHI
Nationwide Children's Hospital, Section of Urology, Columbus, USA
PURPOSE
Open ureteral reimplantation (UR) is the gold standard for the surgical management of vesicoureteral
reflux (VUR). There have been increasing reports on robot-assisted UR but this approach remains
controversial due to reports suggesting increased complications and reduced success compared
to open repair. We present our extensive experience with vesicoscopic ureteral reimplantation (VR)
for primary reflux.
MATERIAL AND METHODS
We retrospectively reviewed all patients who underwent VR at our institution. In this procedure
cross-trigonal reimplantation is done in a manner analogous to open repair under carbon-dioxide
"pneumovesicum". We recorded ages, sex, grade of reflux, operative times, outcomes and
complications.
RESULTS
The series consists of 182 consecutive patients who underwent VR. There were 165 girls and
17 boys, mean age 7.03 years (range 16 months – 38.2 years). Fifteen had failed prior injection
therapy. 135 underwent bilateral repairs and 47 were unilateral. Mean operative time for bilateral
repairs was 197 (112–284) minutes and 169 (99–288) for unilateral. Major complications included
two who developed ureteral obstruction. One resolved with stent placement and the other under-
went reoperative reimplantation. Post-operative VCUG was obtained in 100 which was normal in
93 (93 %). Four of these failures occurred in the first 30 patients. Of the last 49 patients tested,
48 were normal, suggesting an 98 % effective success rate after the learning curve.
CONCLUSIONS
VR is a minimally invasive procedure for the definitive repair of primary reflux. After the learning
curve, success rates are equivalent to open repair. In this video we outline all pertinent steps,
including bladder fixation to the abdominal wall, port placement, mobilization and reimplantation of
the ureters and, finally, port closure.