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Transvesicoscopic ureteral reimplantation in children with bilateral vesicoureteral reflux: surgical technique and results

 Mun Su Chung  ;  Sang Won Han  ;  Hyun Jin Jung  ;  Young Jae Im  ;  Hyun Ho Han  ;  Joon Chae Na  ;  Chang Hee Hong 
 Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol.22(3) : 295-300, 2012 
Journal Title
 Journal of Laparoendoscopic & Advanced Surgical Techniques 
Issue Date
OBJECTIVES: To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field. SUBJECTS AND METHODS: Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR set-up, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time. RESULTS: Of a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, Step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes. CONCLUSIONS: Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
나준채(Na, Joon Chae) ORCID logo https://orcid.org/0000-0003-4449-8472
임영재(Im, Young Jae)
정문수(Chung, Mun Su)
정현진(Jung, Hyun Jin)
한상원(Han, Sang Won) ORCID logo https://orcid.org/0000-0003-0941-1300
한현호(Han, Hyun Ho) ORCID logo https://orcid.org/0000-0002-6268-0860
홍창희(Hong, Chang Hee) ORCID logo https://orcid.org/0000-0002-0946-7702
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